Individual
DR. ANGELIQUE GLOSTER WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8250 KENWOOD CROSSING WAY, #205, CINCINNATI, OH 45236
(513) 948-8444
(513) 948-0756
Mailing address
12061 SHERATON LN, CINCINNATI, OH 45246-1611
(513) 336-6700
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35-067334
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0108387
—
OH
Enumeration date
10/03/2006
Last updated
10/16/2024
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