Provider Demographics
NPI:1659392900
Name:DAVID A WALD MD PA
Entity Type:Organization
Organization Name:DAVID A WALD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-772-2880
Mailing Address - Street 1:2545 E SUNRISE BLVD
Mailing Address - Street 2:# 234
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3203
Mailing Address - Country:US
Mailing Address - Phone:954-772-2880
Mailing Address - Fax:954-772-2848
Practice Address - Street 1:2320 NE 62ND ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2208
Practice Address - Country:US
Practice Address - Phone:954-772-2880
Practice Address - Fax:954-772-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 83180208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5224Medicare PIN