Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 0102049902 | VA |
NPI | 1396773263 |
---|---|
Provider Name | Dr. Edward J Walko |
First Address | Norfolk, VA 23502-2220 |
Second Address | Norfolk, VA 23502-2220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006800238 | (05) | VA |
2300033 | UNITED HEALTH CARE (01) | |
400003 | BLUE CROSS BLUE SHIELD (01) | VA |
890616F | (05) | NC |
F42019 | (02) |