MEDICARE: DR. GLENN ERIC WALDMAN 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	174400000X	Specialist	A62183	CA

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	:	1881665586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN ERIC WALDMAN M.D.

Provider Business Mailing Address
First Line	:	415 ROLLING OAKS DR
Second Line	:	SUITE 190
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91361-1029
Country	:	US
Telephone Number	:	805-494-4797
Fax Number	:	805-494-4810

Provider Business Practice Location Address
First Line	:	415 ROLLING OAKS DR
Second Line	:	SUITE 190
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91361-1029
Country	:	US
Telephone Number	:	805-494-4797
Fax Number	:	805-494-4810

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	08/14/2012

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