Provider Demographics
NPI:1376736330
Name:WALDMAN PLASTIC SURGERY AND DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:WALDMAN PLASTIC SURGERY AND DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-577-5559
Mailing Address - Street 1:17 RIVERSIDE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1383
Mailing Address - Country:US
Mailing Address - Phone:603-577-5559
Mailing Address - Fax:603-577-5579
Practice Address - Street 1:17 RIVERSIDE ST STE 105
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1383
Practice Address - Country:US
Practice Address - Phone:603-577-5559
Practice Address - Fax:603-577-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13474207N00000X
NH13475208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty