MEDICARE: ALLISON WALLER

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	208000000X	Pediatrics Physician	0101266633	VA

General Provider Information

NPI Number	:	1871970046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON WALLER

Provider Business Mailing Address
First Line	:	3600 S GLEBE RD STE 150
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-5604
Country	:	US
Telephone Number	:	703-924-2100
Fax Number	:	703-922-6067

Provider Business Practice Location Address
First Line	:	3600 S GLEBE RD STE 150
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-5604
Country	:	US
Telephone Number	:	703-924-2100
Fax Number	:	703-922-6067

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

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	05/17/2021

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