Provider Demographics
NPI:1790901825
Name:WALKER MERRICK DEVELOPMENTAL PEDIATRICS
Entity Type:Organization
Organization Name:WALKER MERRICK DEVELOPMENTAL PEDIATRICS
Other - Org Name:DEVELOPMENTAL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRI
Authorized Official - Middle Name:F WALKER
Authorized Official - Last Name:MERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-596-3363
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3264
Mailing Address - Country:US
Mailing Address - Phone:410-995-5437
Mailing Address - Fax:301-596-3364
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3264
Practice Address - Country:US
Practice Address - Phone:410-995-5437
Practice Address - Fax:301-596-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034745261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0778OtherCAREFIRST NATIONAL CAPITA
2711674004OtherCIGNA
07105OtherAMERICAID
MDKU63OtherMARYLAND CAREFIRST
1200527OtherUNITED HEALTHCARE
21910OtherPRIORITY PARTNERS
2711674004OtherCIGNA