Provider Demographics
NPI:1952496788
Name:FOLIACO, WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:FOLIACO
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 1:2500 POCOSHOCK PL STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6345
Mailing Address - Country:US
Mailing Address - Phone:804-276-9305
Mailing Address - Fax:804-674-4145
Practice Address - Street 1:2500 POCOSHOCK PL STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6345
Practice Address - Country:US
Practice Address - Phone:804-276-9305
Practice Address - Fax:804-674-4145
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5637309Medicaid
VA5637309Medicaid