Provider Demographics
NPI:1346670619
Name:WALTER, ALICIA C (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:C
Last Name:WALTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:C
Other - Last Name:KILPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1528 WALNUT ST
Mailing Address - Street 2:STE 1101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3621
Mailing Address - Country:US
Mailing Address - Phone:410-472-0900
Mailing Address - Fax:410-472-0900
Practice Address - Street 1:216 MALL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2923
Practice Address - Country:US
Practice Address - Phone:215-390-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058114363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant