Healthcare Provider Details

I. General information

NPI: 1861405706
Provider Name (Legal Business Name): STEPHEN JOSEPH WALL M.D.,PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 400
WASHINGTON DC
20006-1009
US

IV. Provider business mailing address

2021 K ST NW STE 400
WASHINGTON DC
20006-1009
US

V. Phone/Fax

Practice location:
  • Phone: 202-833-3500
  • Fax: 202-833-3503
Mailing address:
  • Phone: 202-833-3500
  • Fax: 202-833-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD 32942
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD32942
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: