1124340757 NPI number — DR. RON WALD MD

Table of content: DR. RON WALD MD (NPI 1124340757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124340757 NPI number — DR. RON WALD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALD
Provider First Name:
RON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124340757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
588 ST. CLEMENTS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORONTO
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
M5N 1M6
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
416-785-2050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST. MICHAEL'S HOSPITAL
Provider Second Line Business Practice Location Address:
30 BOND STREET
Provider Business Practice Location Address City Name:
TORONTO
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
M5B 1W8
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
416-867-3703
Provider Business Practice Location Address Fax Number:
416-867-3709
Provider Enumeration Date:
02/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  224141 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)