MEDICARE: DR. SUSAN JENNIFER WALKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	G49465	CA
2	207NP0225X	Pediatric Dermatology Physician	G49465	CA
3	207NS0135X	Procedural Dermatology Physician	G49465	CA

General Provider Information

NPI Number	:	1952461329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN JENNIFER WALKER M.D.

Provider Business Mailing Address
First Line	:	4347 FESSENDEN ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4032
Country	:	US
Telephone Number	:	301-796-2110
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 WISCONSIN AVE
Second Line	:	NATIONAL NAVAL MEDICAL CENTER
City	:	BETHESDA
State	:	MD
Zip	:	20889-0001
Country	:	US
Telephone Number	:	301-295-5496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	12/30/2013

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