Provider Demographics
NPI:1548307085
Name:WALDMAN PLASTIC SURGERY CENTER
Entity type:Organization
Organization Name:WALDMAN PLASTIC SURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:S. RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-254-5665
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC78369Medicare UPIN
KYG73736Medicare UPIN