Provider Demographics
NPI:1568535706
Name:ROBERT L. WALDRON, II, MD, PA
Entity Type:Organization
Organization Name:ROBERT L. WALDRON, II, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-534-0053
Mailing Address - Street 1:PO BOX 2201
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-2201
Mailing Address - Country:US
Mailing Address - Phone:803-534-0053
Mailing Address - Fax:803-534-0291
Practice Address - Street 1:5 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6863
Practice Address - Country:US
Practice Address - Phone:803-534-0053
Practice Address - Fax:803-534-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADF9701OtherMEDICARE RAILROAD
GADF9701OtherMEDICARE RAILROAD