Individual
MR. GARY DAVID WALDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10512 PARK RD, SUITE 113, CHARLOTTE, NC 28210-8469
(704) 542-8018
(704) 542-7147
Mailing address
10512 PARK RD, SUITE 113, CHARLOTTE, NC 28210-8469
(704) 542-8018
(704) 542-7147
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
26610
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070009176
RAILROAD MEDICARE
NC
05
—
7985246
—
NC
01
—
85246
BLUE CROSS BLUE SHIELD
NC
Enumeration date
03/29/2006
Last updated
04/03/2012
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