Provider Demographics
NPI:1689783631
Name:WALDRON, VINCENT JOHN (M D)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOHN
Last Name:WALDRON
Suffix:
Gender:
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:104 CAROLINA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKNEAL
Mailing Address - State:VA
Mailing Address - Zip Code:24528
Mailing Address - Country:US
Mailing Address - Phone:434-376-2325
Mailing Address - Fax:434-200-1678
Practice Address - Street 1:104 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:BROOKNEAL
Practice Address - State:VA
Practice Address - Zip Code:24528-2643
Practice Address - Country:US
Practice Address - Phone:434-376-2325
Practice Address - Fax:434-376-2081
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200292510AMedicaid
ING84723Medicare UPIN
IN200292510AMedicaid