Individual
DR. REGINALD M WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6104 OLD BRANCH AVENUE, KAISER PERMANENTE, PPQA, 6 WEST, ATTN THERESA BROOKS, TEMPLE HILLS, MD 20748-2518
(301) 702-6100
(301) 702-6367
Mailing address
2101 EAST JEFFERSON STREET, KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS, ROCKVILLE, MD 20852
(301) 816-6660
(301) 816-6308
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101044800
VA
207Q00000X
Family Medicine Physician
Primary
D35317
MD
207Q00000X
Family Medicine Physician
MD16350
DC
Other
Enumeration date
12/28/2006
Last updated
07/08/2007
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