Healthcare Provider Details

I. General information

NPI: 1730508136
Provider Name (Legal Business Name): MARIA C WALLINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # 124 WEILL CORNELL MEDICAL CENTER, DPT OF ANESTHESIOLOGY
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

575 LEXINGTON AVE
NEW YORK NY
10022-6102
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-5412
  • Fax: 646-962-1920
Mailing address:
  • Phone: 212-746-2962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number297391
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number297391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: