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1003203845
JUSTIN RICHARD WAITE
COLUMBIA, MD
NPI
1003203845
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: MD C0005749)
Enumeration Date
2015-04-20
Last Update Date
2018-03-22
Business Address
JUSTIN RICHARD WAITE
5900 CEDAR LN
COLUMBIA, MD 21044-3635
Phone number: 443-718-4067
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Mailing Address
JUSTIN RICHARD WAITE
5000 COX RD
GLEN ALLEN, VA 23060-9263
Phone number: 804-968-5700
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