Healthcare Provider Details

I. General information

NPI: 1659714319
Provider Name (Legal Business Name): JAMIE WALDRON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

4312 WATERFORD VALLEY DR APT 1338
DURHAM NC
27713-8359
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-7938
  • Fax: 617-643-1274
Mailing address:
  • Phone: 501-772-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2017-01530
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number2017-01530
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number2017-01530
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: