Provider Demographics
NPI:1730298472
Name:WALHOUT, JANELLE RENGEL (MD)
Entity type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:RENGEL
Last Name:WALHOUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 5TH AVE.
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10020
Mailing Address - Country:US
Mailing Address - Phone:212-332-3700
Mailing Address - Fax:646-665-4096
Practice Address - Street 1:600 5TH AVE.
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020
Practice Address - Country:US
Practice Address - Phone:212-332-3700
Practice Address - Fax:646-665-4096
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026019207Q00000X
NY323990-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8866815OtherHARBORVIEW MEDICARE
WA8866523OtherUWP MEDICARE
WA8306946Medicaid
WA8866815OtherHARBORVIEW MEDICARE
B18286Medicare UPIN