MEDICARE: DR. PHILIP SCOTT WALERKO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401410605	VA

General Provider Information

NPI Number	:	1043293061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP SCOTT WALERKO D.D.S.

Provider Business Mailing Address
First Line	:	1157 PINEDALE DR
Second Line	:
City	:	BEDFORD
State	:	VA
Zip	:	24523-6638
Country	:	US
Telephone Number	:	540-587-8650
Fax Number	:

Provider Business Practice Location Address
First Line	:	167 W MAIN ST
Second Line	:
City	:	BEDFORD
State	:	VA
Zip	:	24523-1950
Country	:	US
Telephone Number	:	540-586-8106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/08/2007

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