Provider Demographics
NPI:1255421996
Name:WALDMAN, RICHARD M (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
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:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-1528
Mailing Address - Country:US
Mailing Address - Phone:910-642-6121
Mailing Address - Fax:910-642-8457
Practice Address - Street 1:823 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472
Practice Address - Country:US
Practice Address - Phone:910-642-6121
Practice Address - Fax:910-642-8457
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39134208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC898524BMedicaid
NCCD8805OtherRR MCR DR #
NC8524BOtherBCNC DR #
NCN39134OtherSC MCD DR#
NC898524BMedicaid
NC2150381Medicare PIN