Provider Demographics
NPI:1851451520
Name:WALTERS, CHRISTOPHER J (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 WES
Mailing Address - Street 2:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:1225 FAIR LAKES PARKWAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4512
Practice Address - Country:US
Practice Address - Phone:703-934-5700
Practice Address - Fax:703-934-5778
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000828213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
012010M92Medicare ID - Type Unspecified
U82429Medicare UPIN