Provider Demographics
NPI:1164480323
Name:WAITZE, ALAN S (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:WAITZE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 CHASE PKWY
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3346
Mailing Address - Country:US
Mailing Address - Phone:203-755-6677
Mailing Address - Fax:203-573-1982
Practice Address - Street 1:500 CHASE PKWY
Practice Address - Street 2:SUITE 2A
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3346
Practice Address - Country:US
Practice Address - Phone:203-755-6677
Practice Address - Fax:203-573-1982
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-10-28
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Provider Licenses
StateLicense IDTaxonomies
CT038348207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH12779Medicare UPIN
CT140000177Medicare ID - Type Unspecified