Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 17006 | MD |
N | 2251P0200X | Physical Therapist - Pediatrics | 17006 | MD |
N | 2251S0007X | Physical Therapist - Sports | 17006 | MD |
N | 2251X0800X | Physical Therapist - Orthopedic | 17006 | MD |
NPI | 1275526253 |
---|---|
Provider Name | Mr. John Douglass Wallop |
First Address | Annapolis, MD 21401-7353 |
Second Address | Annapolis, MD 21401-7353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 09/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17006 | (02) | MD |
227912 | MAMSI PROVIDER NUMBER (01) | MD |
2621453 | AETNA HMO NUMBER (01) | MD |
53056502 | BC REGION RENDERING # (01) | MD |
7947168 | AETNA NON-HMO NUMBER (01) | MD |
KN59 | BLUE CROSS LOCAL # (01) | MD |
W0290002 | BC FEDERAL, BLUE CHOICE # (01) | MD |