Provider Demographics
NPI:1902156912
Name:WALDO, IRMA M (MD)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:M
Last Name:WALDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PILL HL
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12529-6222
Mailing Address - Country:US
Mailing Address - Phone:518-325-4451
Mailing Address - Fax:
Practice Address - Street 1:62 PILL HL
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NY
Practice Address - Zip Code:12529-6222
Practice Address - Country:US
Practice Address - Phone:518-325-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070669207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine