Provider Demographics
NPI:1366508301
Name:WALKER, GREGORY LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEROY
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 1:3333 N CALVERT ST STE 585
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6514
Mailing Address - Country:US
Mailing Address - Phone:410-235-8858
Mailing Address - Fax:410-235-8904
Practice Address - Street 1:3333 N CALVERT ST STE 585
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6514
Practice Address - Country:US
Practice Address - Phone:410-235-8858
Practice Address - Fax:410-235-8904
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD771001100Medicaid
OW45OtherBLUE CROSS
110072704OtherRAILROAD MEDICARE
W322OtherBLUE CROSS & BLUE CHOICE
8834Medicare ID - Type Unspecified
MD771001100Medicaid