Provider Demographics
NPI:1861587040
Name:WALDROP, WILLIAM M (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:WALDROP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353 CENTER DRIVE
Mailing Address - Street 2:STE 204
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4802
Mailing Address - Country:US
Mailing Address - Phone:757-461-3313
Mailing Address - Fax:757-461-1641
Practice Address - Street 1:6330 NEWTOWN RD
Practice Address - Street 2:STE 625
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4802
Practice Address - Country:US
Practice Address - Phone:757-461-3313
Practice Address - Fax:757-461-1641
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007104448Medicaid
VA007104448Medicaid
VA260000727Medicare PIN