Individual
RICHARD EDMUND WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14355 SOMMERVILLE CT, MIDLOTHIAN, VA 23113
(804) 379-7721
(804) 379-7699
Mailing address
14355 SOMMERVILLE CT, MIDLOTHIAN, VA 23113
(804) 379-7721
(804) 379-7699
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101040746
VA
2084N0400X
Neurology Physician
Primary
0101040746
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010131855
—
VA
Enumeration date
05/04/2006
Last updated
03/24/2011
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