Provider Demographics
NPI:1508185919
Name:WAXMAN, ALLA ULITSKY (DO)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:ULITSKY
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:ULITSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 8500-4081
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-4081
Mailing Address - Country:US
Mailing Address - Phone:215-856-1010
Mailing Address - Fax:215-856-1141
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-938-2100
Practice Address - Fax:215-938-3908
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015954207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102735900 0008Medicaid
PA244292Medicare PIN