Provider Demographics
NPI:1447246426
Name:WALTER, BARRY F (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:F
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY STE 305
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-359-8640
Practice Address - Fax:703-591-6105
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101054026208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7305729Medicaid
DC059090600Medicaid
MD884008300Medicaid
MD884008300Medicaid
DC059090600Medicaid