Individual
DAVID L WAXMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
527 MEDICAL PARK DR STE 400, BRIDGEPORT, WV 26330-9010
(681) 342-3550
(681) 342-3507
Mailing address
527 MEDICAL PARK DR STE 400, BRIDGEPORT, WV 26330-9010
(681) 342-3550
(681) 342-3507
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
14240
WV
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
14240
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720802
BLUE CROSS
—
05
—
0097123000
—
WV
01
—
1362317
UMWA
—
01
—
200004627
RAILROAD MEDICARE
—
01
—
WV14240B
HEALTH PLAN OHIO VALLEY
—
01
—
WV2679A
MEDICARE PTAN
WV
Enumeration date
06/08/2006
Last updated
04/05/2022
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