Basic Information
| Provider Information | |||||||||
| NPI: | 1699705467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALDMAN | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 PLEASANT ST | ||||||||
| Address2: | STE 204 | ||||||||
| City: | NEW LONDON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032575881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026585756 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 KIMBALL AVE STE 115 | ||||||||
| Address2: | |||||||||
| City: | S BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054036841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026585756 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0500X | 0320000527 | VT | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | 207P00000X | 363A00000X | VT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.