Provider Demographics
NPI:1508963810
Name:NAUMANN, WALTER KARL (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:KARL
Last Name:NAUMANN
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 1:105 OLD ENGLE MILL RD
Mailing Address - Street 2:
Mailing Address - City:ACCIDENT
Mailing Address - State:MD
Mailing Address - Zip Code:21520-2096
Mailing Address - Country:US
Mailing Address - Phone:301-746-8376
Mailing Address - Fax:301-746-8376
Practice Address - Street 1:105 OLD ENGLE MILL RD
Practice Address - Street 2:
Practice Address - City:ACCIDENT
Practice Address - State:MD
Practice Address - Zip Code:21520-2096
Practice Address - Country:US
Practice Address - Phone:301-746-8376
Practice Address - Fax:301-746-8376
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025759207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420691600Medicaid
E15143Medicare UPIN
MD420691600Medicaid
MD786L585DMedicare PIN