Provider Demographics
NPI:1174518427
Name:WALKER, CONSTANCE E (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:E
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CONSTANCE
Other - Middle Name:E
Other - Last Name:MCMULLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1839 E GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4839
Mailing Address - Country:US
Mailing Address - Phone:704-864-2685
Mailing Address - Fax:704-864-9363
Practice Address - Street 1:1839 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4839
Practice Address - Country:US
Practice Address - Phone:704-864-2685
Practice Address - Fax:704-864-9363
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01198208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine