Healthcare Provider Details

I. General information

NPI: 1851369193
Provider Name (Legal Business Name): WILLIAM JOSEPH WALDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MAGAURAN DR SUITE 3
STAFFORD SPRINGS CT
06076-4037
US

IV. Provider business mailing address

7 MAGAURAN DR SUITE 3
STAFFORD SPRINGS CT
06076-4037
US

V. Phone/Fax

Practice location:
  • Phone: 860-684-5438
  • Fax: 860-684-9848
Mailing address:
  • Phone: 860-684-5438
  • Fax: 860-684-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19675
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: