Healthcare Provider Details

I. General information

NPI: 1356703011
Provider Name (Legal Business Name): LOUISA WALL WHITESIDES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOUISA KING WALL

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW STE 215
WASHINGTON DC
20016-4368
US

IV. Provider business mailing address

4910 MASSACHUSETTS AVE NW STE 215
WASHINGTON DC
20016-4368
US

V. Phone/Fax

Practice location:
  • Phone: 202-953-0990
  • Fax:
Mailing address:
  • Phone: 202-953-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD047091
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD07091
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD047091
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: