Healthcare Provider Details

I. General information

NPI: 1720089402
Provider Name (Legal Business Name): NAOMI WALDBAUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5187 MAYFIELD RD
LYNDHURST OH
44124-2468
US

IV. Provider business mailing address

PO BOX 567
CHAGRIN FALLS OH
44022-0567
US

V. Phone/Fax

Practice location:
  • Phone: 440-449-1014
  • Fax:
Mailing address:
  • Phone: 216-464-5160
  • Fax: 216-464-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35048448
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: