Basic Information
| Provider Information | |||||||||
| NPI: | 1851451520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALTERS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 WES | ||||||||
| Address2: | KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018166660 | ||||||||
| FaxNumber: | 3018166308 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 FAIR LAKES PARKWAY | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220334512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039345700 | ||||||||
| FaxNumber: | 7039345778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 0103000828 | VA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.