Provider Demographics
NPI:1104887603
Name:WALKER, CHRISTOPHER MARTIN (IDC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARTIN
Last Name:WALKER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 AQUAMARINE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1362
Mailing Address - Country:US
Mailing Address - Phone:757-282-6352
Mailing Address - Fax:
Practice Address - Street 1:USS MINNEAPOLIS-ST PAUL (SSN 708)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09578-2388
Practice Address - Country:US
Practice Address - Phone:757-534-1756
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman