Provider Demographics
NPI:1982617767
Name:REGAN, WENDY P (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:P
Last Name:REGAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:714 AQUIDNECK AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5796
Practice Address - Country:US
Practice Address - Phone:401-846-1139
Practice Address - Fax:401-847-1360
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2020-04-24
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Provider Licenses
StateLicense IDTaxonomies
RIMD10304208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIH17783Medicare UPIN