Provider Demographics
NPI:1124007232
Name:GIANELLE, WALTER DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:DAVID
Last Name:GIANELLE
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 1:2425 N SALISBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2138
Mailing Address - Country:US
Mailing Address - Phone:410-334-6351
Mailing Address - Fax:410-334-6352
Practice Address - Street 1:2425 N SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2138
Practice Address - Country:US
Practice Address - Phone:410-334-6351
Practice Address - Fax:410-334-6352
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044413207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD653941600Medicaid
MD302GMedicare ID - Type Unspecified
F39339Medicare UPIN