Individual
JUSTIN RICHARD WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5900 CEDAR LN, COLUMBIA, MD 21044-3635
(443) 718-4067
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C0005749
MD
Other
Enumeration date
04/20/2015
Last updated
03/22/2018
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