Provider Demographics
NPI:1851390587
Name:WALKER, JASON D (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:WALKER
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 1:1817 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2331
Mailing Address - Country:US
Mailing Address - Phone:302-992-9617
Mailing Address - Fax:302-992-9633
Practice Address - Street 1:4512 KIRKWOOD HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5123
Practice Address - Country:US
Practice Address - Phone:302-992-9617
Practice Address - Fax:302-992-9633
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001164501Medicaid
DE0001164501Medicaid
008665L40Medicare ID - Type Unspecified