Provider Demographics
NPI:1316914716
Name:HOLLOW, WALTER B (MD)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:B
Last Name:HOLLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WALT
Other - Middle Name:
Other - Last Name:HOLLOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9800 4TH AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115
Mailing Address - Country:US
Mailing Address - Phone:206-302-1248
Mailing Address - Fax:206-302-1263
Practice Address - Street 1:9800 4TH AVENUE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-302-1248
Practice Address - Fax:206-302-1263
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015655103T00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8446809Medicaid
8802887Medicare PIN
E99333Medicare UPIN