Provider Demographics
NPI:1912588740
Name:WALDRON, EVAN J (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:J
Last Name:WALDRON
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 WATCHUNG PL
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2030
Mailing Address - Country:US
Mailing Address - Phone:201-674-4944
Mailing Address - Fax:
Practice Address - Street 1:139 WATCHUNG PL
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2030
Practice Address - Country:US
Practice Address - Phone:201-674-4944
Practice Address - Fax:973-661-4482
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program