Provider Demographics
NPI:1306870746
Name:WALDROP, KEVIN L (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:WALDROP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:
Practice Address - Street 1:2006 FRANKLIN ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:256-539-5827
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL363972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL206494Medicaid
AL210283Medicaid
AL244585Medicaid
AL206493Medicaid
AL206522Medicaid
AL245342Medicaid
AL247003Medicaid
009937862OtherMEDICAID OF AL
MS05989862Medicaid
AL207472Medicaid
AL210618Medicaid
AL207779Medicaid
731-04444OtherBLUE CROSS OF AL
AL207471Medicaid
AL213117Medicaid
P00350048OtherRAIL ROAD MEDICARE
AL211059Medicaid
AL245109Medicaid
AL245528Medicaid