Provider Demographics
NPI:1346770427
Name:WALDNER, DERICK (DO)
Entity Type:Individual
Prefix:
First Name:DERICK
Middle Name:
Last Name:WALDNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 HEDGEROW CT
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2408
Mailing Address - Country:US
Mailing Address - Phone:913-244-3081
Mailing Address - Fax:
Practice Address - Street 1:932 HEDGEROW CT
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2408
Practice Address - Country:US
Practice Address - Phone:913-244-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
NJ25MB11374600207L00000X
PAOS021822207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program