Provider Demographics
NPI:1316126626
Name:FAGGETT II, WALTER LEE (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:LEE
Last Name:FAGGETT II
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4013 16TH ST NW
Mailing Address - Street 2:NA
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7001
Mailing Address - Country:US
Mailing Address - Phone:202-723-3100
Mailing Address - Fax:202-442-4790
Practice Address - Street 1:4013 16TH ST NW
Practice Address - Street 2:NA
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7001
Practice Address - Country:US
Practice Address - Phone:202-723-3100
Practice Address - Fax:202-442-4790
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2010-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DC5270207QA0401X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine