Provider Demographics
NPI:1750683090
Name:ROBERT P. WALDMAN, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT P. WALDMAN, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-301-0015
Mailing Address - Street 1:4644 LINCOLN BLVD
Mailing Address - Street 2:STE 540
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6313
Mailing Address - Country:US
Mailing Address - Phone:310-301-0015
Mailing Address - Fax:310-901-5821
Practice Address - Street 1:4644 LINCOLN BLVD
Practice Address - Street 2:STE 540
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6313
Practice Address - Country:US
Practice Address - Phone:310-301-0015
Practice Address - Fax:310-901-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49826207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487689329OtherINDIVIDUAL NPI
CAG49826OtherPTAN