Provider Demographics
NPI:1740259506
Name:WALDEN, EMERSON C JR (MD)
Entity type:Individual
Prefix:DR
First Name:EMERSON
Middle Name:C
Last Name:WALDEN
Suffix:JR
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:PO BOX 416
Mailing Address - Street 2:3608 OFFIT RD.
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-0416
Mailing Address - Country:US
Mailing Address - Phone:410-528-1326
Mailing Address - Fax:410-783-8793
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:SUITE 420
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-528-1326
Practice Address - Fax:410-783-8793
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17154207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118411300Medicaid
MDD94217Medicare UPIN
MD118411300Medicaid