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General NPI Number Information
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NPI Number | 1295962603
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Entity Type | Individual
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Provider Name | MARCUS ANTONIO WALTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 620 JHN PAUL JNS CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PARKVIEW AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23704-1932
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Country | US
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Telephone | 404-374-5867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | ME141572
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License Number State | FL
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