Healthcare Provider Details

I. General information

NPI: 1144267915
Provider Name (Legal Business Name): BRIAN WALITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW SUITE 2A38
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

110 IRVING ST NW SUITE 2A38
WASHINGTON DC
20010-2976
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-2848
  • Fax: 202-877-6292
Mailing address:
  • Phone: 202-877-2848
  • Fax: 202-877-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD32635
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: