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General NPI Number Information
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NPI Number | 1548307085
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Entity Type | Organization
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Legal Business Name | WALDMAN PLASTIC SURGERY CENTER
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 E MAXWELL ST SUITE 303
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City | LEXINGTON
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State | KY
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Zip | 40508-2678
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Country | US
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Telephone | 859-254-5665
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Fax | 859-281-6825
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Provider Business Mailing Address
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Address Line | 125 E MAXWELL ST SUITE 303
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City | LEXINGTON
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State | KY
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Zip | 40508-2678
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Country | US
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Telephone | 859-254-5665
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Fax | 859-281-6825
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Authorized Official
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Title or Position | M.D.
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Name | DR. S. RANDOLPH WALDMAN
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Credential | M.D.
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Telephone | 859-254-5665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 19124
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License Number State | KY
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