Provider Demographics
NPI:1154426880
Name:WALSH, ELIZABETH REARDON (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:REARDON
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:STONE
Other - Last Name:REARDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:900 ELMGROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-6236
Mailing Address - Country:US
Mailing Address - Phone:585-426-4100
Mailing Address - Fax:585-426-2026
Practice Address - Street 1:900 ELMGROVE ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-6236
Practice Address - Country:US
Practice Address - Phone:585-426-4100
Practice Address - Fax:585-426-3701
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P010225721OtherEXCELLUS BLUE CHOICEE
NY02380110Medicaid
NY7701666OtherMVP UPSTATE DHP
NYP010225721OtherBLUE SHIELD OF ROCHESTER
NYMDH518OtherPREFERRED CARE
7429371OtherAETNA US HEALTHCARE
RC60225721OtherPOMCO