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General NPI Number Information
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NPI Number | 1346770427
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Entity Type | Individual
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Provider Name | DERICK WALDNER DO
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Gender | Male
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 559 W GERMANTOWN PIKE
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City | NORRISTOWN
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State | PA
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Zip | 19403-4250
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Country | US
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Telephone | 484-622-1248
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Fax | 484-622-1269
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Provider Business Mailing Address
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Address Line | 101 E OLNEY AVE STE 400
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City | PHILADELPHIA
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State | PA
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Zip | 19120-2470
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Country | US
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Telephone | 215-456-1825
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Fax | 215-456-5926
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MB11374600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | OS021822
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License Number State | PA
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