Provider Demographics
NPI:1003038274
Name:WALKER, MARCELLUS ANDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLUS
Middle Name:ANDRE
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 26TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2417
Mailing Address - Country:US
Mailing Address - Phone:914-671-2775
Mailing Address - Fax:
Practice Address - Street 1:2094 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3509
Practice Address - Country:US
Practice Address - Phone:718-240-0516
Practice Address - Fax:718-240-0564
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039838E207R00000X
NY189578A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty