NPIMap

Individual provider Active NPI

Carl Jay Waldman, MD

  • Neurology Physician
  • West Chester, PA
National Provider Identifier
1750371274
Registry record updated Mar 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
0101058795 Issued in VA
Practice address
440 E Marshall St
West Chester, PA 19380-5414
Phone
(610) 696-8900
NPI assigned
Oct 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 0101058795 VA Primary
Neurology Physician 2084N0400X MD459437 PA

Addresses

Primary practice location

440 E Marshall St
West Chester, PA 19380-5414

Mailing address

1101 Sam Perry Blvd
Ste 414
Fredericksburg, VA 22401-4466
Phone (540) 899-1354

Other identifiers 1

IdentifierTypeStateIssuer
7112114MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161220002356 PA Practitioner - Neurology 1153518683 Reassigns benefits to 2 organizations
I20190424003264 VA Practitioner - Neurology 1153518683 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Northwestern University Feinberg Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone (540) 741-1100

220 Executive Ctr Pkwy
Fredericksburg, VA 22401-3107
Phone (540) 899-2900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101058795VAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Nov 28, 2016 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Nov 28, 2016 Accepting new patients
University of Penn-Medical Group CurrentSince Oct 16, 2017 Accepting new patients
Pathology Associates of Fredericksburg PTR Current Accepting new patients
University of Penn-Medical Group Current Accepting new patients
Mary Washington Healthcare Physicians Neurology CurrentSince Mar 31, 2019 Accepting new patients
Mary Washington Healthcare Physicians CurrentSince Mar 31, 2019 Accepting new patients
University of Penn-Medical Group CurrentSince Oct 16, 2017 Accepting new patients

Locations

3400 Civic Center Blvd
Fl 2
Philadelphia, PA 19104

440 E Marshall St
West Chester, PA 19380
Phone (610) 436-8611

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

1101 Sam Perry Blvd
Ste 414
Fredericksburg, VA 22401
Phone (540) 899-1354

1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100

220 Executive Center Pkwy
Fredericksburg, VA 22401
Phone (540) 899-2900

Organizations & group practices 8

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1750371274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 SAM PERRY BLVD",
            "address_2": "STE 414",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014466",
            "telephone_number": "540-899-1354",
            "fax_number": "540-899-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 E MARSHALL ST",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193805414",
            "telephone_number": "610-696-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDMAN",
        "first_name": "CARL",
        "middle_name": "JAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "VA",
            "license": "0101058795",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD459437",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7112114",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Chester, PA

Sources for this page

Verify at the official NPI Registry.