Provider Demographics
NPI:1669402376
Name:ALBERTA M VALLIS MD PC
Entity type:Organization
Organization Name:ALBERTA M VALLIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER OF ALBERTA M VALLIS
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-234-5713
Mailing Address - Street 1:1846 PARK ROAD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINIGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-234-5713
Mailing Address - Fax:202-462-5250
Practice Address - Street 1:1846 PARK ROAD NW
Practice Address - Street 2:
Practice Address - City:WASHINIGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-234-5713
Practice Address - Fax:202-462-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD254052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010987100Medicaid
MD786011100OtherMARYLAND MEDICAID
F45726Medicare UPIN