Provider Demographics
NPI:1861405706
Name:WALL, STEPHEN JOSEPH (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:WALL
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 K ST NW STE 400
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1009
Mailing Address - Country:US
Mailing Address - Phone:202-833-3500
Mailing Address - Fax:202-833-3503
Practice Address - Street 1:2021 K ST NW STE 400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1009
Practice Address - Country:US
Practice Address - Phone:202-833-3500
Practice Address - Fax:202-833-3503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD 32942207Y00000X
DCMD32942207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB593 - 0004OtherBLUE CROSS /BLUE SHIELD
DCB593 - 0004OtherBLUE CROSS /BLUE SHIELD
H37880Medicare UPIN
G01400W00Medicare ID - Type Unspecified