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1164159257
BRENDAN WALLACE
BANGOR, ME
NPI
1164159257
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
208800000X Urology
(Licence: ME MD25666)
Enumeration Date
2022-08-08
Last Update Date
2022-08-08
Business Address
BRENDAN WALLACE MD
55 BROADWAY
BANGOR, ME 04401-5201
Phone number: 207-947-0469
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Mailing Address
BRENDAN WALLACE MD
98 FOUNTAIN ST
BANGOR, ME 04401-3848
Phone number: 613-806-2243
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