Provider Demographics
NPI:1598737462
Name:WAINWRIGHT, BRENT DENMAN (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:DENMAN
Last Name:WAINWRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06777-1628
Mailing Address - Country:US
Mailing Address - Phone:484-868-9998
Mailing Address - Fax:860-393-1079
Practice Address - Street 1:18 E SHORE RD
Practice Address - Street 2:
Practice Address - City:NEW PRESTON
Practice Address - State:CT
Practice Address - Zip Code:06777-1628
Practice Address - Country:US
Practice Address - Phone:484-868-9998
Practice Address - Fax:860-393-1079
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234018207N00000X
CT43818207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03454060Medicaid
NYA400093374OtherMEDICARE PTAN
NYA400093374OtherMEDICARE PTAN
NYA400093374OtherMEDICARE PTAN