1750315164 NPI number — KIMBERLI WALKER DPT

Table of content: KIMBERLI WALKER DPT (NPI 1750315164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750315164 NPI number — KIMBERLI WALKER DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
KIMBERLI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHIELDS
Provider Other First Name:
KIMBERLI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750315164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7651 MATAPEAKE BUSINESS DR STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDYWINE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20613-3042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-782-4600
Provider Business Mailing Address Fax Number:
301-782-4601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7651 MATAPEAKE BUSINESS DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANDYWINE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20613-3042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-782-4600
Provider Business Practice Location Address Fax Number:
301-782-4601
Provider Enumeration Date:
07/10/2006

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: 225100000X , with the licence number:  20891 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 173323ZAKW . This is a "MARYLAND MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52 1054342 . This is a "GMO GROUP TAX ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 644684 . This is a "BCBS MD PROVIDER#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 46950019 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 172197YZW . This is a "DC MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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