Provider Demographics
NPI:1437450004
Name:EMERSON WALDEN JR, INC
Entity Type:Organization
Organization Name:EMERSON WALDEN JR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-802-6184
Mailing Address - Street 1:9991 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1155
Mailing Address - Country:US
Mailing Address - Phone:410-802-6184
Mailing Address - Fax:410-783-8793
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:SUITE 420
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-528-1326
Practice Address - Fax:410-783-8793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17154207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118411300Medicaid
MD8801Medicare PIN
MDD94217Medicare UPIN