Provider Demographics
NPI:1265723340
Name:M. WAISMAN, M.D.P.A.
Entity type:Organization
Organization Name:M. WAISMAN, M.D.P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:WAISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-526-1667
Mailing Address - Street 1:4101 GREENBRIAR ST STE 115
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5244
Mailing Address - Country:US
Mailing Address - Phone:713-526-1667
Mailing Address - Fax:713-526-0391
Practice Address - Street 1:100 E MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1778
Practice Address - Country:US
Practice Address - Phone:970-925-8908
Practice Address - Fax:713-526-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30584207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00P968Medicare UPIN