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General NPI Number Information
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NPI Number | 1285889287
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Entity Type | Organization
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Legal Business Name | HAMPTON ROADS ARTHRITIS CENTER
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 2115 EXECUTIVE DR SUITE 6C
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City | HAMPTON
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State | VA
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Zip | 23666-2499
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Country | US
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Telephone | 757-874-7246
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Fax | 757-826-9415
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Provider Business Mailing Address
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Address Line | 2115 EXECUTIVE DR SUITE 6C
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City | HAMPTON
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State | VA
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Zip | 23666-2499
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Country | US
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Telephone | 757-874-7246
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Fax | 757-826-9415
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Authorized Official
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Title or Position | CEO
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Name | DR. WALTER RUDOLPH WALLINGFORD
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Credential | M.D.
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Telephone | 767-874-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 0101024223
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License Number State | VA
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