Individual
MICHAEL ANTHONY WALTICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
82 COOPER STREET, PRINGLE, PA 18704
(570) 574-2390
Mailing address
695 KINKAID RD, ANNAPOLIS, MD 21402-1006
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/06/2018
Last updated
09/06/2023
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