Provider Demographics
NPI:1750371274
Name:WALDMAN, CARL JAY (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:JAY
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SAM PERRY BLVD
Mailing Address - Street 2:STE 414
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4466
Mailing Address - Country:US
Mailing Address - Phone:540-899-1354
Mailing Address - Fax:540-899-1359
Practice Address - Street 1:440 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5414
Practice Address - Country:US
Practice Address - Phone:610-696-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010587952084N0400X
PAMD4594372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7112114Medicaid
G95573Medicare UPIN
VA7112114Medicaid