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Individual

GLORIA WALTERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
100 EMANCIPATION DR, HAMPTON, VA 23667-0001
(757) 722-9961
Mailing address
100 EMANCIPATION DR, HAMPTON, VA 23667-0001

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20665
MS
207L00000X
Anesthesiology Physician
35088765
OH
207L00000X
Anesthesiology Physician
48081
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
302I059650
MEDICARE PTAN
MS
05
490043000
MN
01
P00806766
RAILROAD PTAN
MS
Enumeration date
01/10/2006
Last updated
10/08/2012
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