1851082184 NPI number — MR. MARC L WALKER, JR. JR.

Table of content: MR. MARC L WALKER, JR. JR. (NPI 1851082184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851082184 NPI number — MR. MARC L WALKER, JR. JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER, JR.
Provider First Name:
MARC
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851082184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1295 BEACON ST BROOKLINE
Provider Second Line Business Mailing Address:
#655
Provider Business Mailing Address City Name:
DORCHESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-904-4424
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 GLENWAY STREET
Provider Second Line Business Practice Location Address:
APT 3 UNIT 5
Provider Business Practice Location Address City Name:
DORCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02121-0212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-904-4424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)