Provider Demographics
NPI:1871970046
Name:WALLER, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S GLEBE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-5604
Mailing Address - Country:US
Mailing Address - Phone:703-924-2100
Mailing Address - Fax:703-922-6067
Practice Address - Street 1:3600 S GLEBE RD STE 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-5604
Practice Address - Country:US
Practice Address - Phone:703-924-2100
Practice Address - Fax:703-922-6067
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266633208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics