Provider Demographics
NPI:1932496221
Name:VALLIS, ALBERTA M (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTA
Middle Name:M
Last Name:VALLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 PARK RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1019
Mailing Address - Country:US
Mailing Address - Phone:202-234-5713
Mailing Address - Fax:202-462-5250
Practice Address - Street 1:1846 PARK RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1019
Practice Address - Country:US
Practice Address - Phone:202-234-5713
Practice Address - Fax:202-462-5250
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD254052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010987100Medicaid