Provider Demographics
NPI:1548290778
Name:WALKER, JAMES DREW (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DREW
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:D
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:198 FERN CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-0471
Mailing Address - Country:US
Mailing Address - Phone:304-262-1707
Mailing Address - Fax:
Practice Address - Street 1:198 FERN CREEK LN
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-0471
Practice Address - Country:US
Practice Address - Phone:304-262-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22646207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020624620001Medicaid
WVCA7030OtherRAILROAD MEDICARE GRP #
AZXPY180750Medicaid
WV3810008673Medicaid
WV4642267OtherAETNA
WVP00471919OtherRAILROAD MEDICARE
AZXPY180750Medicaid
WVWA6036571Medicare PIN
WV4642267OtherAETNA