Individual
THEODORE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11140 MONTGOMERY RD, CINCINNATI, OH 45249-2309
(513) 792-7800
(513) 792-7807
Mailing address
237 WILLIAM HOWARD TAFT RD, 2ND FLOOR, CBO 2-3, CINCINNATI, OH 45219-2610
(513) 792-7800
(513) 792-7807
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35046812
OH
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
35046812
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000019745
ANTHEM
—
01
—
000000238182
ANTHEM MIDDLETOWN
—
05
—
0549464
—
OH
01
—
0642403
AETNA
—
05
—
100335970
—
IN
01
—
2520401
UNITED
—
05
—
64860562
—
KY
Enumeration date
04/18/2006
Last updated
10/23/2020
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