=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992033096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD JOSEPH WAITT N.P.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2009
-----------------------------------------------------
Last Update Date | 07/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 WINTER ST
-----------------------------------------------------
City | WALTHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02451-1424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-419-8354
-----------------------------------------------------
Fax | 781-419-8479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 WINTER ST
-----------------------------------------------------
City | WALTHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02451-1424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-419-8354
-----------------------------------------------------
Fax | 781-419-8479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 274605
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------