MEDICARE: WILLIAM J. WALDRON CRNA

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	163W00000X	Registered Nurse	RN320844L	PA
2	367500000X	Certified Registered Nurse Anesthetist	047978	PA
3	367500000X	Certified Registered Nurse Anesthetist	RNA243044	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	430075687	OTHER	PA	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50003218	OTHER	PA	CAPITAL ADVANTAGE
2	211803000	OTHER	PA	INDEP. BLUE CROSS
3	78003	OTHER	PA	GEISINGER
4	1433520	OTHER	PA	KHP CENTRAL
6	1433520	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1073500633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J. WALDRON CRNA

Provider Business Mailing Address
First Line	:	24 HOSPITAL LN
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-1329
Country	:	US
Telephone Number	:	207-454-7521
Fax Number	:	207-454-9247

Provider Business Practice Location Address
First Line	:	24 HOSPITAL LN
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-1329
Country	:	US
Telephone Number	:	207-454-7521
Fax Number	:	207-454-9247

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	09/25/2024

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Directions to “ WILLIAM J. WALDRON CRNA” Practice Location

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