Provider Demographics
NPI:1073500633
Name:WALDRON, WILLIAM J (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:WALDRON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CHESTNUT ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2614
Mailing Address - Country:US
Mailing Address - Phone:267-322-7701
Mailing Address - Fax:
Practice Address - Street 1:325 CHESTNUT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2614
Practice Address - Country:US
Practice Address - Phone:267-322-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN320844L163W00000X
PA047978367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1433520OtherHIGHMARK
PA50003218OtherCAPITAL ADVANTAGE
PA78003OtherGEISINGER
PA1433520OtherKHP CENTRAL
PA211803000OtherINDEP. BLUE CROSS
PA430075687OtherRAIL ROAD MEDICARE
PA430075687OtherRAIL ROAD MEDICARE
PA50003218OtherCAPITAL ADVANTAGE