Healthcare Provider Details

I. General information

NPI: 1669402376
Provider Name (Legal Business Name): ALBERTA M VALLIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1846 PARK ROAD NW
WASHINIGTON DC
20010
US

IV. Provider business mailing address

1846 PARK ROAD NW
WASHINIGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-234-5713
  • Fax: 202-462-5250
Mailing address:
  • Phone: 202-234-5713
  • Fax: 202-462-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD25405
License Number StateDC

VIII. Authorized Official

Name: ALBERTA M VALLIS
Title or Position: DIRECTOR OWNER OF ALBERTA M VALLIS
Credential: MD
Phone: 202-234-5713