Provider Demographics
NPI:1760510911
Name:WALTNER, NANCY M (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:M
Last Name:WALTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 N AIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5103
Mailing Address - Country:US
Mailing Address - Phone:845-357-4888
Mailing Address - Fax:845-368-0022
Practice Address - Street 1:11 N AIRMONT RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5103
Practice Address - Country:US
Practice Address - Phone:845-357-4888
Practice Address - Fax:845-368-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159723207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00887518Medicaid
NYA62417Medicare UPIN
NY00887518Medicaid