Basic Information
| Provider Information | |||||||||
| NPI: | 1467436782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYDNOR | ||||||||
| FirstName: | WALTON | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11889 | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245061889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349473944 | ||||||||
| FaxNumber: | 8666178273 | ||||||||
| Practice Location | |||||||||
| Address1: | 2215 LANDOVER PL | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245012115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349473944 | ||||||||
| FaxNumber: | 8666178273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 03/15/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 0101040738 | VA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 110045837 | 01 | VA | MEDICARE RAILROAD CARRIER | OTHER | 6061079 | 05 | VA | MEDICAID | P00789319 | 01 | MEDICARE RAILROAD CARRIER | OTHER |