Provider Demographics
NPI:1912268087
Name:WALDON, MIA LYNNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MIA
Middle Name:LYNNE
Last Name:WALDON
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:19785 CRYSTAL ROCK DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:301-515-2901
Mailing Address - Fax:301-515-5950
Practice Address - Street 1:19785 CRYSTAL ROCK DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874
Practice Address - Country:US
Practice Address - Phone:301-515-2901
Practice Address - Fax:301-515-5950
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
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Provider Licenses
StateLicense IDTaxonomies
MDC0004737363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical