Provider Demographics
NPI:1598035628
Name:WALD, BARTON ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARTON
Middle Name:ROY
Last Name:WALD
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 1:440 E HUNTINGTON DR
Mailing Address - Street 2:SUITE 200, SECOND FLOOR
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3776
Mailing Address - Country:US
Mailing Address - Phone:626-254-8110
Mailing Address - Fax:626-254-8230
Practice Address - Street 1:440 E HUNTINGTON DR
Practice Address - Street 2:SUITE 200, SECOND FLOOR
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3776
Practice Address - Country:US
Practice Address - Phone:626-254-8110
Practice Address - Fax:626-254-8230
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36871302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization