Provider Demographics
NPI:1609095082
Name:WALETZKY, JEREMY PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:PETER
Last Name:WALETZKY
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 1:633 E ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2991
Mailing Address - Country:US
Mailing Address - Phone:202-486-7174
Mailing Address - Fax:877-792-0172
Practice Address - Street 1:633 E ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2991
Practice Address - Country:US
Practice Address - Phone:202-486-7174
Practice Address - Fax:877-792-0172
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0412832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry