Provider Demographics
NPI:1821170598
Name:WAITE, TIMOTHY C (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:WAITE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 GANNETT DR STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-7940
Mailing Address - Country:US
Mailing Address - Phone:207-828-0048
Mailing Address - Fax:207-772-3743
Practice Address - Street 1:280 GANNETT DR STE B
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-7940
Practice Address - Country:US
Practice Address - Phone:207-828-0048
Practice Address - Fax:207-772-3743
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0152572084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MERB7OtherANTHEM
ME269210099Medicaid