Provider Demographics
NPI:1285615476
Name:PALADINO, WALTER P (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:P
Last Name:PALADINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:661 UNIVERSITY LN
Practice Address - Street 2:INTERNAL MEDICINE, STE B
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-2243
Practice Address - Country:US
Practice Address - Phone:540-661-3004
Practice Address - Fax:540-661-3060
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072120174400000X
VA0101259104207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285615476Medicaid
OH2009687Medicaid
VAVVJ706AMedicare PIN
OHB39617Medicare UPIN