Provider Demographics
NPI:1194966648
Name:WAVERLY INTERNAL MEDICINE, LLC
Entity type:Organization
Organization Name:WAVERLY INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NDIDI
Authorized Official - Middle Name:BONIQUE
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-601-6434
Mailing Address - Street 1:11165 STRATFIELD CT
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1625
Mailing Address - Country:US
Mailing Address - Phone:410-442-8065
Mailing Address - Fax:410-442-8067
Practice Address - Street 1:11165 STRATFIELD CT
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1650
Practice Address - Country:US
Practice Address - Phone:410-442-8065
Practice Address - Fax:410-442-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty