Provider Demographics
NPI:1518984046
Name:WALFORD, TANYECH PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYECH
Middle Name:PATRICIA
Last Name:WALFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 N MACLAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1328
Mailing Address - Country:US
Mailing Address - Phone:818-898-1388
Mailing Address - Fax:
Practice Address - Street 1:1172 N MACLAY AVE
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1328
Practice Address - Country:US
Practice Address - Phone:818-898-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75693OtherSTATE MEDICAL BOARD
CAH77326Medicare UPIN
CAW19365Medicare ID - Type Unspecified
MDD0068583OtherMARYLAND BOARD OF PHYSICIANS