Healthcare Provider Details

I. General information

NPI: 1053403170
Provider Name (Legal Business Name): FREDERICK W. WALKER, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 ROCK SPRING RD
FOREST HILL MD
21050-2621
US

IV. Provider business mailing address

2005 ROCK SPRING RD
FOREST HILL MD
21050-2621
US

V. Phone/Fax

Practice location:
  • Phone: 410-836-0909
  • Fax: 410-893-2325
Mailing address:
  • Phone: 410-836-0909
  • Fax: 410-893-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberDOO20463
License Number StateMD

VIII. Authorized Official

Name: DR. FREDERICK WILLIAM WALKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-836-0909