MARY MELANIE WALLER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036119328

License Status

ACTIVE

Business

First Name

MARY

Middle

MELANIE

Last Name

WALLER

Suffix

Business Name

MARY MELANIE WALLER MD

Original Issue Date

08/30/2007

Effective Date

04/10/2023

Expiration Date

07/31/2026

City

OLNEY

State

Zip

62450

County

RICHLAND

Ever Disciplined

LastModifiedDate

04/10/2023