Provider Demographics
NPI:1932283272
Name:AYCOCK-WALMAN, NANCY R
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:R
Last Name:AYCOCK-WALMAN
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:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:GLYNDON
Mailing Address - State:MD
Mailing Address - Zip Code:21071-0301
Mailing Address - Country:US
Mailing Address - Phone:410-517-1263
Mailing Address - Fax:410-517-1266
Practice Address - Street 1:106 BUSINESS CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-517-1263
Practice Address - Fax:410-517-1266
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD378800800Medicaid
MDF72894Medicare UPIN