Provider Demographics
NPI:1033141973
Name:WAYMAN, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:WAYMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 629
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-758-5700
Mailing Address - Fax:585-758-1293
Practice Address - Street 1:2365 CLINTON AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2645
Practice Address - Country:US
Practice Address - Phone:585-758-5700
Practice Address - Fax:585-758-1293
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176463207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5327333OtherAETNA
NYP010176463OtherBLUE SHIELD
NY0600048OtherGHI
NY000523907002OtherCOMMUNITY BLUE
NYMDH268OtherPREFERRED CARE
NY01234073Medicaid
NY040017649OtherRAIL ROAD MEDICARE
NYG0182467590OtherBLUE CHOICE
NYP010176463OtherBLUE SHIELD
NY000523907002OtherCOMMUNITY BLUE