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General NPI Number Information
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NPI Number | 1437450004
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Entity Type | Organization
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Legal Business Name | EMERSON WALDEN JR, INC
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 301 SAINT PAUL PL SUITE 420
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City | BALTIMORE
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State | MD
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Zip | 21202-2102
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Country | US
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Telephone | 410-528-1326
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Fax | 410-783-8793
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Provider Business Mailing Address
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Address Line | 9991 VILLAGE GREEN DR
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City | WOODSTOCK
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State | MD
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Zip | 21163-1155
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Country | US
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Telephone | 410-802-6184
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Fax | 410-783-8793
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Authorized Official
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Title or Position | OWNER
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Name | DR. EMERSON WALDEN JR.
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Credential | M.D.
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Telephone | 410-802-6184
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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 | D17154
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License Number State | MD
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