Most Relevant Information
Provider Data
| NPI Number: | 1003203845 |
| Provider Name: | JUSTIN RICHARD WAITE |
| Entity Type: | Individual |
| Taxonomy Code: | 363AS0400X |
| Specialty: | Physician Assistant |
| License Number: | C0005749 |
Most Important Dates
| Enumeration Date: | 04/20/2015 |
| Last Updated: | 03/22/2018 |
Provider Practice Location
5900 CEDAR LN
COLUMBIA
MD
210443635
Practice Location Phone/Fax
| Phone: | 4437184067 |
| Fax: |
Provider Mailing Location
5000 COX RD
GLEN ALLEN
VA
230609263
Provider Mailing Phone/Fax
| Phone: | 8049685700 |
| Fax: |