Provider Demographics
NPI:1629147632
Name:WALKER, LILLIE MARQUE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LILLIE
Middle Name:MARQUE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LILLIE
Other - Middle Name:MARQUE
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-645-1523
Mailing Address - Fax:301-645-6812
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3240
Practice Address - Country:US
Practice Address - Phone:301-645-1523
Practice Address - Fax:301-645-6812
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005644363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical