Healthcare Provider Details

I. General information

NPI: 1396773263
Provider Name (Legal Business Name): EDWARD J WALKO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 LOWERY RD SUITE 100
NORFOLK VA
23502-2220
US

IV. Provider business mailing address

5665 LOWERY RD SUITE 100
NORFOLK VA
23502-2220
US

V. Phone/Fax

Practice location:
  • Phone: 757-422-2966
  • Fax: 757-422-4563
Mailing address:
  • Phone: 757-422-2966
  • Fax: 757-422-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0102049902
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: