Healthcare Provider Details

I. General information

NPI: 1417280231
Provider Name (Legal Business Name): WALTER C LOCKHART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 FOREST DR #2
ANNAPOLIS MD
21403-1019
US

IV. Provider business mailing address

1616 FOREST DR #2
ANNAPOLIS MD
21403-1019
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-8663
  • Fax: 410-268-6000
Mailing address:
  • Phone: 410-266-8663
  • Fax: 410-268-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: WALTER C LOCKHART
Title or Position: PHYSICAN AND OWNER
Credential: MD
Phone: 443-481-6476