MEDICARE: GARY JAY WAXMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	0101059225	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023008018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY JAY WAXMAN M.D.

Provider Business Mailing Address
First Line	:	816 INDEPENDENCE BLVD
Second Line	:	STE 2A
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6010
Country	:	US
Telephone Number	:	757-363-6712
Fax Number	:	757-363-6204

Provider Business Practice Location Address
First Line	:	816 INDEPENDENCE BLVD
Second Line	:	STE 2A
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6010
Country	:	US
Telephone Number	:	757-363-6712
Fax Number	:	757-363-6204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/05/2009

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