Provider Demographics
NPI:1255075545
Name:WALSH, MARIA E
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13633 KINGSMAN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4608
Mailing Address - Country:US
Mailing Address - Phone:703-863-2593
Mailing Address - Fax:
Practice Address - Street 1:1764 LANIER PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2118
Practice Address - Country:US
Practice Address - Phone:703-863-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant