Provider Demographics
NPI:1366608499
Name:WALDMAN, STEVEN RANDOLPH (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RANDOLPH
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 1:125 E MAXWELL ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2678
Mailing Address - Country:US
Mailing Address - Phone:859-254-5665
Mailing Address - Fax:859-281-6825
Practice Address - Street 1:125 E MAXWELL ST
Practice Address - Street 2:SUITE 303
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2678
Practice Address - Country:US
Practice Address - Phone:859-254-5665
Practice Address - Fax:859-281-6825
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist