Provider Demographics
NPI:1083053755
Name:WALSH, REBECCA (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE ST STE 405
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5128
Mailing Address - Country:US
Mailing Address - Phone:225-928-2555
Mailing Address - Fax:225-929-9685
Practice Address - Street 1:500 RUE DE LA VIE ST STE 405
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5128
Practice Address - Country:US
Practice Address - Phone:225-928-2555
Practice Address - Fax:225-929-9685
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3379582080N0001X
OK344892080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine