Healthcare Provider Details

I. General information

NPI: 1356348510
Provider Name (Legal Business Name): MONIKA M WALTERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11325 SEVEN LOCKS RD SUITE 238
POTOMAC MD
20854-3205
US

IV. Provider business mailing address

11325 SEVEN LOCKS RD SUITE 238
POTOMAC MD
20854-3205
US

V. Phone/Fax

Practice location:
  • Phone: 301-299-8930
  • Fax: 301-299-8933
Mailing address:
  • Phone: 301-299-8930
  • Fax: 301-299-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0047608
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD21478
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: