Organization Active NPI

Robert P. Waldman, M.D. a Professional Corporation

  • Nephrology Physician
  • Marina del Rey, CA
National Provider Identifier
1750683090
Registry record updated Nov 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
G49826 Issued in CA
Legal business name
ROBERT P. WALDMAN, M.D. A PROFESSIONAL CORPORATION
Practice address
4644 Lincoln Blvd
Ste 540
Marina del Rey, CA 90292-6313
Phone
(310) 301-0015
Fax
(310) 901-5821
NPI assigned
Nov 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2010

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

Authorized official

Name
Dr. Robert P. Waldman, M.D.
Title
President
Phone
(310) 301-0015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X G49826 CA Primary

Addresses

Primary practice location

4644 Lincoln Blvd
Ste 540
Marina del Rey, CA 90292-6313

Mailing address

4644 Lincoln Blvd
Ste 540
Marina del Rey, CA 90292-6313
Phone (310) 301-0015

Other identifiers 2

IdentifierTypeStateIssuer
1487689329OtherCAINDIVIDUAL NPI
G49826OtherCAPTAN

National Provider Directory

National Provider Directory

Locations

4644 Lincoln Blvd
Ste 540
Marina del Rey, CA 90292
Phone (310) 301-0015

NPI Registry JSON

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

{
    "created_epoch": "1290038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1750683090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4644 LINCOLN BLVD",
            "address_2": "STE 540",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926313",
            "telephone_number": "310-301-0015",
            "fax_number": "310-901-5821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4644 LINCOLN BLVD",
            "address_2": "STE 540",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926313",
            "telephone_number": "310-301-0015",
            "fax_number": "310-901-5821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT P. WALDMAN, M.D. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-18",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "WALDMAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-301-0015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G49826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1487689329",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "G49826",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marina del Rey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.