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NPI Code Detail

MEDICARE: DR. DOUGLAS WALTMAN PH.D.

MEDICARE: DR. DOUGLAS WALTMAN PH.D.
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
1103TC0700XClinical Psychologist3553OH

General Provider Information

NPI Number : 1285850180
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS WALTMAN PH.D.
Provider Business Mailing Address
First Line : 9002 MENTOR AVE
Second Line :
City : MENTOR
State : OH
Zip : 44060-6302
Country : US
Telephone Number : 440-205-1008
Fax Number : 440-205-1047
Provider Business Practice Location Address
First Line : 9002 MENTOR AVE
Second Line :
City : MENTOR
State : OH
Zip : 44060-6302
Country : US
Telephone Number : 440-205-1008
Fax Number : 440-205-1047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 11/28/2011

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