Provider Demographics
NPI:1619186574
Name:BRANFORD NORTH BRANFORD PEDIATRICS,PC
Entity Type:Organization
Organization Name:BRANFORD NORTH BRANFORD PEDIATRICS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-481-5591
Mailing Address - Street 1:682 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2907
Mailing Address - Country:US
Mailing Address - Phone:203-481-5591
Mailing Address - Fax:203-481-5594
Practice Address - Street 1:999 FOXON RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1287
Practice Address - Country:US
Practice Address - Phone:203-484-7334
Practice Address - Fax:203-484-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004174132Medicaid