Elizabeth D Waller, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD34862 Issued in SC

Practice address

2113 Adams GRV Ste 101
Columbia, SC 29203-6957

Phone

(803) 256-0531

Fax

(803) 765-9052

NPI assigned

Jun 18, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: edonahue95402@direct-guthrie.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Pediatrics & Adolescent Care, PA

  • Pediatrics Physician
  • Columbia, SC
  • NPI 1306805056
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1740543537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2113 ADAMS GRV STE 101",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036957",
            "telephone_number": "803-256-0531",
            "fax_number": "803-765-9052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2113 ADAMS GRV STE 101",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036957",
            "telephone_number": "803-256-0531",
            "fax_number": "803-765-9052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "ELIZABETH",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "MD34862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sallie C Wallace, ATC
• Seniya Wallace
• Mohammed Naim Wallam, MD
• Benjamin Matthew Waller, LPC
• Edward D Waller, PH.D.
• Chadwick Glenn Walls
• Karen Craig Walpole, M.D.
• Cassandra Walsh, APRN
• Eileen Marie Walsh, M.D.
• Elizabeth Walsh

• Pediatrics Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Pediatrics Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.