Active NPI
Maxeen Wyatt, MT
- Specialist
- South Portland, ME
National Provider Identifier
1336308188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MT3231
- Practice address
- 380 Western Ave
South Portland, ME 04106-1720 - Phone
- (207) 282-5110
- NPI assigned
- Jun 6, 2008
- Last updated
- Jun 6, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MT3231 | ME | Primary |
Addresses
Primary practice location
380 Western Ave
South Portland, ME 04106-1720
Mailing address
380 Western Ave
South Portland, ME 04106-1720
Phone (207) 239-4240
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200890 | Other | ME | ANTHEM BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT3231 | ME | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212710400000",
"number": "1336308188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "380 WESTERN AVE",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041061720",
"telephone_number": "207-239-4240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "380 WESTERN AVE",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041061720",
"telephone_number": "207-282-5110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "MAXEEN",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-06",
"last_updated": "2008-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "ME",
"license": "MT3231",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
"identifier": "200890",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.