Individual
MR. JOHN DOUGLASS WALLOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2661 RIVA RD, BLDG 600, SUITE 601, ANNAPOLIS, MD 21401-7353
(410) 266-6626
(410) 266-3026
Mailing address
2661 RIVA RD, BLDG 600, SUITE 601, ANNAPOLIS, MD 21401-7353
(410) 266-6626
(410) 266-3026
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17006
MD
2251P0200X
Pediatric Physical Therapist
17006
MD
2251S0007X
Sports Physical Therapist
17006
MD
2251X0800X
Orthopedic Physical Therapist
17006
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227912
MAMSI PROVIDER NUMBER
MD
01
—
2621453
AETNA HMO NUMBER
MD
01
—
53056502
BC REGION RENDERING #
MD
01
—
7947168
AETNA NON-HMO NUMBER
MD
01
—
KN59
BLUE CROSS LOCAL #
MD
01
—
W0290002
BC FEDERAL, BLUE CHOICE #
MD
Enumeration date
08/25/2005
Last updated
05/09/2012
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