Healthcare Provider Details

I. General information

NPI: 1912919267
Provider Name (Legal Business Name): WALKER LYERLY IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N GLEBE RD SUITE 303
ARLINGTON VA
22207-3558
US

IV. Provider business mailing address

5920 HUBBARD DRIVE
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-1290
  • Fax: 703-841-1315
Mailing address:
  • Phone: 703-532-2430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101048137
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101048137
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: