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General NPI Number Information
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NPI Number | 1225120207
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Entity Type | Individual
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Provider Name | WAVERLY STANFORD ANDREWS IV MD
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 301 SULLIVAN WAY
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City | TRENTON
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State | NJ
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Zip | 08628-3406
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Country | US
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Telephone | 606-633-1557
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Fax |
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Provider Business Mailing Address
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Address Line | 1207 PINE GROVE RD
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City | YARDLEY
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State | PA
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Zip | 19067-3307
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Country | US
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Telephone | 215-295-5317
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA05006900
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License Number State | NJ
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