Gary David Waldman, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

26610 Issued in NC

Practice address

10512 Park Rd
Suite 113
Charlotte, NC 28210-8469

Phone

(704) 542-8018

Fax

(704) 542-7147

NPI assigned

Mar 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Pinnacle Dermatology, SC

  • Dermatology Physician
  • Joliet, IL
  • NPI 1861930984

  NC

  Medicare reassignment NPD

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333411200000",
    "number": "1487615795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10512 PARK RD",
            "address_2": "SUITE 113",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108469",
            "telephone_number": "704-542-8018",
            "fax_number": "704-542-7147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10512 PARK RD",
            "address_2": "SUITE 113",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108469",
            "telephone_number": "704-542-8018",
            "fax_number": "704-542-7147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDMAN",
        "first_name": "GARY",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2012-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "26610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7985246",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070009176",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "85246",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP.
• Ashley Monique Wala, NP
• Laura M Walby, MD
• Trinetta Walcott
• Kayla Amanda Suddeth Walden, DC
• Lauren Chapman Waldron, PA-C
• Erika L Waldrop, CRNA
• Raymond Paul Waldrop III, MD
• Cassandra Jane Walen, PHARMD
• Heather Lynn Waleski, FNP

• Dermatology Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.