Provider Demographics
NPI:1437129665
Name:WALDMAN, JEREMY (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIVERSIDE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1304
Mailing Address - Country:US
Mailing Address - Phone:603-577-5559
Mailing Address - Fax:603-577-5579
Practice Address - Street 1:17 RIVERSIDE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1304
Practice Address - Country:US
Practice Address - Phone:603-577-5559
Practice Address - Fax:603-577-5579
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH13475208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I52983Medicare UPIN