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Individual

NOAM A VANDERWALDE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
7945 WOLF RIVER BLVD, GERMANTOWN, TN 38138-1733
(901) 683-0055
(901) 685-2969
Mailing address
7714 POPLAR AVE STE 200, ATTN: CREDENTIALING, GERMANTOWN, TN 38138-3941
(901) 322-9080
(901) 922-6722

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
23666
MS
2085R0001X
Radiation Oncology Physician
Primary
51603
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
08408361
MS
05
Q009036
TN
Enumeration date
05/19/2009
Last updated
04/05/2016
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