Healthcare Provider Details

I. General information

NPI: 1861492134
Provider Name (Legal Business Name): EDWIN WALKER MD, MSPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 CHAPMAN RD STE 205C
NEWARK DE
19702-5449
US

IV. Provider business mailing address

260 CHAPMAN RD STE 205C
NEWARK DE
19702-5449
US

V. Phone/Fax

Practice location:
  • Phone: 302-533-7582
  • Fax: 302-533-7584
Mailing address:
  • Phone: 302-533-7582
  • Fax: 302-533-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number22890
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: