Provider Demographics
NPI:1174492599
Name:WALDORF, LAUREN AVALON
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:AVALON
Last Name:WALDORF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 DIXON AVE APT 2204
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3995
Mailing Address - Country:US
Mailing Address - Phone:940-257-5953
Mailing Address - Fax:
Practice Address - Street 1:8200 DIXON AVE APT 2204
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3995
Practice Address - Country:US
Practice Address - Phone:940-257-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program