Basic Information
| Provider Information | |||||||||
| NPI: | 1003142027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TADROS | ||||||||
| FirstName: | WAGDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 UNION ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042105475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077530506 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61 UNION ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077530506 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2009 | ||||||||
| LastUpdateDate: | 10/27/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PR5608 | ME | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.