MEDICARE: CARLA WALDRON MD

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	207VG0400X	Gynecology Physician	200278	NY

General Provider Information

NPI Number	:	1558313619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA WALDRON MD

Provider Business Mailing Address
First Line	:	356 W 18TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-4401
Country	:	US
Telephone Number	:	212-271-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	356 W 18TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-4401
Country	:	US
Telephone Number	:	212-271-7200
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/11/2012

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