Healthcare Provider Details

I. General information

NPI: 1649927088
Provider Name (Legal Business Name): WALTER BANFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WALTER BANFIELD WALTER BANFIELD

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE STREET
CHARLOTTESVILLE VA
22908
US

V. Phone/Fax

Practice location:
  • Phone: 804-832-9813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0105233
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: