Provider Demographics
NPI:1902884141
Name:PARRIS, WAYNE H (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:H
Last Name:PARRIS
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:PO BOX 64481
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4481
Mailing Address - Country:US
Mailing Address - Phone:410-836-7010
Mailing Address - Fax:
Practice Address - Street 1:620 BOULTON ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4255
Practice Address - Country:US
Practice Address - Phone:410-893-0480
Practice Address - Fax:410-893-9796
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014326207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003331600Medicaid
MDD0014326OtherSTATE LICENSE NUMBER
MD111300300Medicaid
MDD0014326OtherSTATE LICENSE NUMBER
MD111300300Medicaid