Individual provider Active NPI

Larry A Waskow, PA-C

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1710949003
Registry record updated May 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0000274 Issued in MD
Practice address
1838 Greene Tree Rd
Suite 460
Baltimore, MD 21208-6391
Phone
(410) 581-1600
NPI assigned
Apr 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0000274 MD Primary

Addresses

Primary practice location

1838 Greene Tree Rd
Suite 460
Baltimore, MD 21208-6391

Mailing address

25 Crossroads Dr
Suite 306
Owings Mills, MD 21117-5421
Phone (410) 581-1600

Other identifiers 1

IdentifierTypeStateIssuer
970005850OtherMDR/R MEDICARE PROVIDER #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040510001318 MD Practitioner - Physician Assistant 3274522792 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Chesapeake Urology Associates LLC CurrentSince Mar 1, 2004 Accepting new patients
Chesapeake Urology Associates, LLC Past Accepting new patients

Locations

25 Crossroads Dr
Ste 306
Owings Mills, MD 21117
Phone (443) 231-1681

1838 Greene Tree Rd
Ste 460
Pikesville, MD 21208
Phone (410) 581-8140

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399334400000",
    "number": "1710949003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 CROSSROADS DR",
            "address_2": "SUITE 306",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211175421",
            "telephone_number": "410-581-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1838 GREENE TREE RD",
            "address_2": "SUITE 460",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212086391",
            "telephone_number": "410-581-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASKOW",
        "first_name": "LARRY",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2014-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0000274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R/R MEDICARE PROVIDER #",
            "identifier": "970005850",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.