Healthcare Provider Details

I. General information

NPI: 1417029398
Provider Name (Legal Business Name): JOSEPH JUDE WALDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 NORMAN DR
LEBANON PA
17042-7444
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-2700
  • Fax: 717-272-2757
Mailing address:
  • Phone: 717-851-7134
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD424273
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: