Healthcare Provider Details

I. General information

NPI: 1629009881
Provider Name (Legal Business Name): ROCKLAN DAVID WALKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E LANCASTER AVE
WAYNE PA
19087-4220
US

IV. Provider business mailing address

372 W LANCASTER AVE
WAYNE PA
19087-3924
US

V. Phone/Fax

Practice location:
  • Phone: 610-688-8807
  • Fax: 610-688-2970
Mailing address:
  • Phone: 610-688-8807
  • Fax: 610-688-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS010474L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOSO10474L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: