Provider Demographics
NPI:1629134168
Name:SCARBOROUGH, WALTER AVERY JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:AVERY
Last Name:SCARBOROUGH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1004 DRESSER COURT
Mailing Address - Street 2:STE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7325
Mailing Address - Country:US
Mailing Address - Phone:919-876-0090
Mailing Address - Fax:919-212-3155
Practice Address - Street 1:1004 DRESSER COURT
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7325
Practice Address - Country:US
Practice Address - Phone:919-876-0090
Practice Address - Fax:919-212-3155
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC155782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8974743Medicaid
NC8974743Medicaid