DR. KENNETH WILLIAM WALLER (NPI# 1518921238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1518921238 |
Entity Type | Individual |
Full Name | DR. KENNETH WILLIAM WALLER |
Credential | M.D. |
Practice Address |
100 Emancipation Dr Hampton VA 23667-0001 |
Practice Telephone | 7577229961 |
Practice Fax Number | 7577266078 |
Mailing Telephone | 7577229961 |
Mailing Fax Number | 7577266078 |
Enumeration Date | 2006-04-12 |
Last Update Date | 2007-07-08 |
Gender Code | M |
Is Sole Proprietor | X |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
X | 2081P0004X |
Physical Medicine & Rehabilitation Specialization: Spinal Cord Injury Medicine |
0101040108 | VA | Allopathic & Osteopathic Physicians |
X | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
0101040108 | VA | Allopathic & Osteopathic Physicians |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841546959 | Kenneth Russell Waller IIi | Veterinarian | 2015 Linden Dr, Room 2058, Madison, WI 53706-1100 | 2012-07-25 |
Street Address |
100 EMANCIPATION DR |
City | HAMPTON |
State | VA |
Zip Code | 23667-0001 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073518916 | Therese P Montoya | Physical Medicine & Rehabilitation | 100 Emancipation Dr, Hampton, VA 23667 | 2005-06-16 |
1285241570 | Larry N. Wootten | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-09-30 |
1487266631 | Jason Jemale Hall | Counselor | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-08-19 |
1790395085 | Caitlyn Moody | Pharmacist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-08-03 |
1639788268 | Shan S. Wong | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-07-29 |
1205454352 | Charity Seitz | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-07-06 |
1629694617 | Michael William Olsavicky | Pharmacist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-06-25 |
1659997914 | John David Kauffman | Pharmacist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-06-23 |
1790301406 | Lineisha Williams | Social Worker | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-06-18 |
1215557335 | Katy Hughes Fedorko | Physician Assistant | 100 Emancipation Dr, Hampton, VA 23667-2906 | 2020-04-18 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124447388 | Brian Pho Bui | Psychiatry & Neurology | Hampton Veterans Affairs 100 Emancipation Dr, Hampton, VA 23667 | 2014-04-15 |
1275786741 | Melissa Ann Palka | Nurse Practitioner | Hampton Va Medical Center, 100 Emancipation Dr., Hampton, VA 23667 | 2008-10-28 |
1639107741 | Lawrence Monroe Brown Jr. | Social Worker | Hampton Vamc, 100 Emancipation Dr, Hampton, VA 23667 | 2006-06-29 |
1578528030 | Harold Steven Smuckler | Family Medicine | Department of Veterans Affairs, Primary Care, 100 Emancipation Lane, Hampton, VA 23667 | 2006-04-19 |
1013978451 | Donald Epstein | Psychologist | 1000 Emancipation Drive, Hampton, VA 23667 | 2006-03-28 |
1225098593 | Maryanne Schaeffer | Dietitian, Registered | 100 Emancipation Drive, Hampton, VA 23667 | 2006-03-23 |
1376074773 | Linda Carol Whitfield | Case Manager/Care Coordinator | 100 Emancipation Drive, Hampton, VA 23667 | 2017-03-27 |
1316217516 | Wallace Danny Johnson IIi | Occupational Therapist | 100 Emancipation Drive, Hampton, VA 23667 | 2012-01-04 |
1386929164 | Amber Mizuki | Dietitian, Registered | 100 Emancipation Drive, Bldg 116, Hampton, VA 23667 | 2011-10-12 |
1447549266 | Irene Nanghui Yi | Pharmacist | 100 Emancipation Dr., Hampton Vamc, Hampton, VA 23667 | 2011-04-01 |
Find all providers in zip 23667 |
Taxonomy Code | 2081P0004X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Physical Medicine & Rehabilitation |
Specialization | Spinal Cord Injury Medicine |
A physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal cord dysfunction by working in an interdisciplinary manner. Care is provided to patients of all ages on a lifelong basis and covers related medical, physical, psychological and vocational disabilities and complications. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. ACGME Accredited Residency Program Requirements: 1 year of training with 3-5 years in relevant specialty for a total of 4-6 years. ABMS Approved Subspecialty Certificate: (Physical Medicine and Rehabilitation) |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932161171 | Anthony Vincent Cassini | Physical Medicine & Rehabilitation | 100 Emancipation Dr, 590-128, Hampton, VA 23667-0001 | 2006-04-04 |
1154382547 | Laurie Lindblom | Physical Medicine & Rehabilitation | 100 Emancipation Dr, 128, Hampton, VA 23667-0001 | 2006-03-28 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417165143 | Steven Deschner | Physical Medicine & Rehabilitation | 7489 Right Flank Rd, Suite 300, Mechanicsville, VA 23116-3845 | 2007-05-18 |
1326096470 | Kenneth Edward Moore | Physical Medicine & Rehabilitation | Mcguire Vamc, 1201 Broad Rock Rd, Richmond, VA 23249 | 2006-05-04 |
1275928426 | Elisabeth Katherine Acker | Physical Medicine & Rehabilitation | 1201 Broad Rock Blvd, Richmond, VA 23249-0001 | 2015-04-04 |
1295942332 | Deborah Caruso | Physical Medicine & Rehabilitation | 1201 Broad Rock Blvd, Spinal Cord Injury, Richmond, VA 23249-0001 | 2007-05-17 |
1346355054 | Lance L. Goetz | Physical Medicine & Rehabilitation | 1201 Broad Rock Blvd, Richmond, VA 23249-0001 | 2006-08-20 |
1386662203 | Prabhakaran K Nambiar | Physical Medicine & Rehabilitation | 95 Medical Park Blvd, Petersburg, VA 23805-9280 | 2006-07-18 |
1770517807 | Mcv Associated Physicians | Physical Medicine & Rehabilitation | 1250 E Marshall Street, Mcv Hospitals Vcu Medical Center, Richmond, VA 23298-0510 | 2006-07-11 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.