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General NPI Number Information
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NPI Number | 1386609881
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Entity Type | Individual
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Provider Name | THEODORE WALLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 11140 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45249-2309
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Country | US
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Telephone | 513-792-7800
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Fax | 513-792-7807
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Provider Business Mailing Address
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Address Line | 237 WILLIAM HOWARD TAFT RD 2ND FLOOR, CBO 2-3
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City | CINCINNATI
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State | OH
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Zip | 45219-2610
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Country | US
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Telephone | 513-792-7800
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Fax | 513-792-7807
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35046812
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 35046812
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License Number State | OH
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