Healthcare Provider Details

I. General information

NPI: 1619944097
Provider Name (Legal Business Name): ADAM B WALDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2222 PHILADELPHIA DRIVE
DAYTON OH
45406-1891
US

IV. Provider business mailing address

PO BOX 640446
CINCINNATI OH
45264-0446
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-2612
  • Fax:
Mailing address:
  • Phone: 937-293-0247
  • Fax: 937-293-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35074015W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: