Provider Demographics
NPI:1255366340
Name:WALDER, MICHAEL A (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:WALDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:240 SHARROWVALE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2714
Mailing Address - Country:US
Mailing Address - Phone:856-287-1788
Mailing Address - Fax:856-546-0666
Practice Address - Street 1:JEFFERSON UNIVERSITY HOSPITALS
Practice Address - Street 2:2201 CHAPEL AVE
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002
Practice Address - Country:US
Practice Address - Phone:856-347-7716
Practice Address - Fax:856-546-0666
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB0210422085R0202X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1120701Medicaid
NJ1120701Medicaid
NJD07037Medicare UPIN