Provider Demographics
NPI:1902178874
Name:WALLS, PHILIP DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:DOUGLAS
Last Name:WALLS
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 1:711 HICKORY LOT RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1428
Mailing Address - Country:US
Mailing Address - Phone:410-823-8281
Mailing Address - Fax:
Practice Address - Street 1:711 HICKORY LOT RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-1428
Practice Address - Country:US
Practice Address - Phone:410-823-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD178322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry