Healthcare Provider Details

I. General information

NPI: 1831950625
Provider Name (Legal Business Name): COLIN S WALTERS MD P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 02/07/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

4622 FIELDSTONE LN NW
WASHINGTON DC
20008-1001
US

V. Phone/Fax

Practice location:
  • Phone: 703-725-0128
  • Fax:
Mailing address:
  • Phone: 703-504-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: COLIN S WALTERS
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 703-725-0128