Healthcare Provider Details

I. General information

NPI: 1750030375
Provider Name (Legal Business Name): CATHERINE WALLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE SMILEY MD

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S NEW MIDDLETOWN RD STE 203
MEDIA PA
19063-5255
US

IV. Provider business mailing address

176 S NEW MIDDLETOWN RD STE 203
MEDIA PA
19063-5255
US

V. Phone/Fax

Practice location:
  • Phone: 610-566-7300
  • Fax:
Mailing address:
  • Phone: 610-566-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD495421
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: