Healthcare Provider Details

I. General information

NPI: 1528282787
Provider Name (Legal Business Name): LATASHIA DIONNE WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 FLEET ST ATTN: OBGYN DEPARTMENT
BALTIMORE MD
21224-4230
US

IV. Provider business mailing address

655 WATKINS MILL RD STE 4TH
GAITHERSBURG MD
20879-3301
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2008014398
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: