Healthcare Provider Details

I. General information

NPI: 1477505055
Provider Name (Legal Business Name): LAURA J WALDRON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N EASTOWN RD
LIMA OH
45807-2268
US

IV. Provider business mailing address

951 COMMERCE PKWY SUITE 101
LIMA OH
45804-4040
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-4699
  • Fax: 419-998-4688
Mailing address:
  • Phone: 419-998-4575
  • Fax: 419-998-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME114172
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35052128
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier04647
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerPARAMOUNT
# 2
IdentifierP00160325
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier0615641
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 4
Identifier735059
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerBUCKEYE
# 5
Identifier000000345736
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: