Provider Demographics
NPI:1730271420
Name:WAH, MICHAEL DAVID (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:WAH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DULANEY GATE CT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3011
Mailing Address - Country:US
Mailing Address - Phone:410-529-3303
Mailing Address - Fax:410-529-7980
Practice Address - Street 1:4337 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2143
Practice Address - Country:US
Practice Address - Phone:410-529-3303
Practice Address - Fax:410-529-7980
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3012446OtherAETNA
MD60312OtherOPTIMUM CHOICE
MDF5170001OtherGHMSI
MD42231909OtherCAREFIRST OF MD
MD778165OtherAARP
MD3012446OtherAETNA
MD60312OtherOPTIMUM CHOICE