Provider Demographics
NPI:1548266117
Name:WALDMAN, JEFFRY T (MD)
Entity type:Individual
Prefix:
First Name:JEFFRY
Middle Name:T
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 791128
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1128
Mailing Address - Country:US
Mailing Address - Phone:703-391-2030
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:6201 CENTREVILLE RD
Practice Address - Street 2:# 100
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2446
Practice Address - Country:US
Practice Address - Phone:703-263-9600
Practice Address - Fax:703-266-1452
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101050682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5618959Medicaid
VA285938OtherANTHEM
VA5618959Medicaid
00A356F22Medicare ID - Type Unspecified