Individual
DR. GIACOMO COLVER WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19 E 98TH ST, 7TH FL, STE A, BOX #1259, NY, NY 10029-6574
(212) 241-0949
(212) 534-2654
Mailing address
19 E 98TH ST, 7TH FL, STE A, BOX #1259, NY, NY 10029-6574
(212) 241-0949
(212) 534-2654
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
125.077143
IL
208600000X
Surgery Physician
Primary
322610
NY
390200000X
Student in an Organized Health Care Education/Training Program
125.077143
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125.077143
ILLINOISE DFPR
IL
01
—
322610
NEW YORK STATE EDUCATION DEPARTMENT OFFICE OF THE PROFESSIONS
NY
Enumeration date
03/26/2018
Last updated
07/23/2023
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