Provider Demographics
NPI:1104395656
Name:AL-HERTANI, WALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:WALLA
Middle Name:
Last Name:AL-HERTANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:300 LONGWOOD AVE, BOSTON CHILDREN'S HOSPITAL.
Mailing Address - Street 2:5TH FLOOR, HUNNEWELL BUILDING
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-9572
Mailing Address - Fax:617-730-0211
Practice Address - Street 1:300 LONGWOOD AVE, BOSTON CHILDREN'S HOSPITAL.
Practice Address - Street 2:5TH FLOOR, HUNNEWELL BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-9572
Practice Address - Fax:617-730-0211
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA277572207SG0201X
ZZ024227207SG0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)