Provider Demographics
NPI:1609817261
Name:WALZ, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:WALZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41640 CARSEY RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:45710-8939
Mailing Address - Country:US
Mailing Address - Phone:614-325-4572
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST STE 201
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1431
Practice Address - Country:US
Practice Address - Phone:330-375-7055
Practice Address - Fax:234-312-2301
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD607036152084N0400X
OH350611722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0957237Medicaid
OH0957237Medicaid