Provider Demographics
NPI:1063487353
Name:WALTER, PHILIP S (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4374 NEW TOWN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2865
Mailing Address - Country:US
Mailing Address - Phone:757-259-6770
Mailing Address - Fax:757-259-6794
Practice Address - Street 1:4374 NEW TOWN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2865
Practice Address - Country:US
Practice Address - Phone:757-259-6770
Practice Address - Fax:757-259-6794
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010111790Medicaid
E43367Medicare UPIN
006240S33Medicare ID - Type Unspecified