Provider Demographics
NPI:1447292511
Name:WALDROP, PRESTON ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:ADAM
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:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:
Practice Address - Street 1:101 KNOTBREAK ROAD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7304
Practice Address - Country:US
Practice Address - Phone:540-444-4020
Practice Address - Fax:540-444-4021
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046000207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3933260001OtherADMINISTAR FEDERAL
VA006401104Medicaid
VA200040420OtherRAILROAD MEDICARE
VA700201861OtherCIGNA
VA4409453OtherAETNA
VA127779OtherSOUTHERN HEALTH
VA286129OtherMAMSI
VA452548OtherANTHEM
VA542006922OtherUNITED HEALTHCARE
VA452548OtherANTHEM
VAD13220Medicare UPIN