MEDICARE: ALAN S. WAITZE 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	207T00000X	Neurological Surgery Physician	038348	CT

General Provider Information

NPI Number	:	1164480323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN S. WAITZE M.D.

Provider Business Mailing Address
First Line	:	500 CHASE PKWY
Second Line	:	SUITE 2A
City	:	WATERBURY
State	:	CT
Zip	:	06708-3346
Country	:	US
Telephone Number	:	203-755-6677
Fax Number	:	203-573-1982

Provider Business Practice Location Address
First Line	:	500 CHASE PKWY
Second Line	:	SUITE 2A
City	:	WATERBURY
State	:	CT
Zip	:	06708-3346
Country	:	US
Telephone Number	:	203-755-6677
Fax Number	:	203-573-1982

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/28/2016

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