Basic Information
| Provider Information | |||||||||
| NPI: | 1477505055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALDRON | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 COMMERCE PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458044040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199984575 | ||||||||
| FaxNumber: | 4199984586 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 N EASTOWN RD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458072268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199984699 | ||||||||
| FaxNumber: | 4199984688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME114172 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 35052128 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04647 | 01 | OH | PARAMOUNT | OTHER | P00160325 | 01 | OH | RAILROAD MEDICARE | OTHER | 0615641 | 05 | OH | MEDICAID | 735059 | 01 | OH | BUCKEYE | OTHER | 000000345736 | 01 | OH | ANTHEM | OTHER |