Provider Demographics
NPI:1679890636
Name:WALTROUS, JUSTIN D (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:D
Last Name:WALTROUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8096 EDWIN RAYNOR BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6837
Mailing Address - Country:US
Mailing Address - Phone:443-702-2453
Mailing Address - Fax:443-702-2478
Practice Address - Street 1:8096 EDWIN RAYNOR BLVD STE C
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6837
Practice Address - Country:US
Practice Address - Phone:443-702-2453
Practice Address - Fax:443-702-2478
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2017-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD772492081S0010X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine