Individual provider Active NPI

Nadirah Patricia Waites, MD

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1336825801
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD495318 Issued in PA
Practice address
3401 N Broad St
Philadelphia, PA 19140-5189
Phone
(215) 707-2400
NPI assigned
Jun 27, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD495318 PA Primary

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140-5189

Mailing address

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-2400

Other practice location 1

5201 Haverford Ave
Philadelphia, PA 19139-1401
Phone (267) 930-5412

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230717000956 PA Order and Referring Only - Family PracticePractitioner - Family Practice 6800256348

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD495318PAMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779840000000",
    "number": "1336825801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405189",
            "telephone_number": "215-707-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5201 Haverford Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191391401",
            "country_code": "US",
            "telephone_number": "267-930-5412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAITES",
        "first_name": "NADIRAH",
        "middle_name": "PATRICIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-27",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD495318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.