David Louis Waller Jr., PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

MA001013L Issued in PA

Practice address

60 Township Line Rd
Elkins Park, PA 19027-2220

Phone

(215) 663-6800

Fax

(215) 663-6547

NPI assigned

May 3, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241308800000",
    "number": "1023242286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7435 ELIZABETH RD",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190273322",
            "telephone_number": "215-782-2223",
            "fax_number": "215-782-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 TOWNSHIP LINE RD",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272220",
            "telephone_number": "215-663-6800",
            "fax_number": "215-663-6547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "DAVID",
        "middle_name": "LOUIS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-03",
        "last_updated": "2009-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA001013L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Watermark Wellness
• Samantha Waters, RD

• Surgical Physician Assistant in Elkins Park, PA
• Providers in Elkins Park, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.