Basic Information
| Provider Information | |||||||||
| NPI: | 1588746838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAINGOLD | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11109 PARKVIEW PLAZA DR # 117 | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451701 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11141 PARKVIEW PLAZA DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604256030 | ||||||||
| FaxNumber: | 2604256028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME113489 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A96791 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD446542 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0435924 | KS | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 01071080A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.