Healthcare Provider Details

I. General information

NPI: 1790901825
Provider Name (Legal Business Name): WALKER MERRICK DEVELOPMENTAL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY SUITE 125
COLUMBIA MD
21044-3264
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY SUITE 125
COLUMBIA MD
21044-3264
US

V. Phone/Fax

Practice location:
  • Phone: 410-995-5437
  • Fax: 301-596-3364
Mailing address:
  • Phone: 410-995-5437
  • Fax: 301-596-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberD0034745
License Number StateMD

VIII. Authorized Official

Name: DR. HENRI F. WALKER MERRICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-596-3363