NPI 1003203845

Justin Richard Waite

Practitioner Surgical Physician Assistant Columbia, MD

Practice location

Address: 5900 Cedar Ln, Columbia, MD 21044-3635
Phone: (443) 718-4067
Mailing address: 5000 Cox Rd, Glen Allen, VA 23060-9263

Registered specialties

Surgical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AS0400X Licence C0005749 (MD)

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Registry record

NPI: 1003203845
Entity type: Individual
Sex (as registered): Male
NPI issued: 20 Apr 2015
Record last updated: 22 Mar 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.