Healthcare Provider Details

I. General information

NPI: 1124007232
Provider Name (Legal Business Name): WALTER DAVID GIANELLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 N SALISBURY BLVD
SALISBURY MD
21801-2138
US

IV. Provider business mailing address

2425 N SALISBURY BLVD
SALISBURY MD
21801-2138
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-6351
  • Fax: 410-334-6352
Mailing address:
  • Phone: 410-334-6351
  • Fax: 410-334-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0044413
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: