Individual
DOUGLAS WAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1650 GRAND CONCOURSE, BRONX, NY 10457
(718) 992-7669
Mailing address
1650 GRAND CONCOURSE, BRONX, NY 10457
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
194142
NY
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
194142
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01566343
—
NY
Enumeration date
11/24/2006
Last updated
06/03/2022
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