Healthcare Provider Details

I. General information

NPI: 1437129665
Provider Name (Legal Business Name): JEREMY WALDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RIVERSIDE ST SUITE 105
NASHUA NH
03062-1304
US

IV. Provider business mailing address

17 RIVERSIDE ST SUITE 105
NASHUA NH
03062-1304
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-5559
  • Fax: 603-577-5579
Mailing address:
  • Phone: 603-577-5559
  • Fax: 603-577-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number13475
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: