Provider Demographics
NPI:1578120044
Name:WAYMAN, ELI J (MD)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:J
Last Name:WAYMAN
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 1:222 WILLOW VALLEY LAKES DR STE 1900
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9674
Mailing Address - Country:US
Mailing Address - Phone:717-517-5350
Mailing Address - Fax:717-517-5351
Practice Address - Street 1:222 WILLOW VALLEY LAKES DR STE 1900
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9674
Practice Address - Country:US
Practice Address - Phone:717-517-5350
Practice Address - Fax:717-517-5351
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine