Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD424669 | PA |
N | 2084N0400X | Neurologist | MD424669 | PA |
N | 2084N0400X | Neurologist | MT179625 | PA |
Y | 2084N0402X | Child Neurologist | MD424669 | PA |
NPI | 1205991361 |
---|---|
Provider Name | Amy Waldman |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 18/04/2013 |