Provider Demographics
NPI:1588689715
Name:WALSH, ERIC JR (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WALSH
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2601
Mailing Address - Country:US
Mailing Address - Phone:415-796-2242
Mailing Address - Fax:415-796-3841
Practice Address - Street 1:2395 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2601
Practice Address - Country:US
Practice Address - Phone:415-796-2242
Practice Address - Fax:415-796-3841
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT062432207Q00000X
CAA77058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A770580Medicaid
CT062432OtherCT LIC
CA00A770580Medicaid