Robert Evan Waxman, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3039 Issued in NH

Practice address

1 Medical Center Dr
Lebanon, NH 03756-0001

Phone

(603) 650-5000

Fax

(603) 640-1228

NPI assigned

Sep 28, 2023

Reactivated

Apr 9, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NH, VT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dartmouth-Hitchcock Clinic

  • Family Medicine Physician
  • Manchester, NH
  • NPI 1386697803
  Medicare reassignment NPD
• Mary Hitchcock Memorial Hospital

  • General Acute Care Hospital
  • Lebanon, NH
  • NPI 1023092053
  Medicare reassignment NPD (past)
• Dartmouth-Hitchcock Clinic

  • Internal Medicine Physician
  • Lebanon, NH
  • NPI 1548210198
  NPD
• Mary Hitchcock Memorial Hospital

  • Psychiatric Hospital
  • Hampstead, NH
  • NPI 1699584219
  NPD

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

{
    "created_epoch": "1695859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1043099088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 STEVENS AVENUE",
            "address_2": "HERSEY HALL, ROOM 108",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037560001",
            "telephone_number": "603-650-5000",
            "fax_number": "603-640-1228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "716 Stevens Avenue",
            "address_2": "Hersey Hall, Room 108",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "04103",
            "country_code": "US",
            "telephone_number": "207-221-4529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAXMAN",
        "first_name": "ROBERT",
        "middle_name": "EVAN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-28",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "deactivation_date": "2024-05-01",
        "reactivation_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "3039",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Susan Waters Davis, MD
• Renea Marie Watkins, RDH
• Olivia Parsons Watson
• Lesley A Watts
• Melanie Rachel Watts, M.D.
• Olivia C. Weale, PA-C
• Darian Chanel Weaver
• Patricia Ann Webster, CRNA
• Tracy B Webster, FNP
• Jonathan T Weed, MD

• Physician Assistant in Lebanon, NH
• Providers in Lebanon, NH by specialty
• Physician Assistant in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.