Healthcare Provider Details

I. General information

NPI: 1003950569
Provider Name (Legal Business Name): ROBERT P WAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MONTVALE AVE
STONEHAM MA
02180-3647
US

IV. Provider business mailing address

92 MONTVALE AVE STE 1400
STONEHAM MA
02180-3629
US

V. Phone/Fax

Practice location:
  • Phone: 781-279-7040
  • Fax: 781-279-8340
Mailing address:
  • Phone: 781-279-7040
  • Fax: 781-279-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number265203
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35C.003050
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberMD61233140
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number22698
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number141560
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: