Provider Demographics
NPI:1588864375
Name:WALSH, TIMOTHY PETER (RNP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PETER
Last Name:WALSH
Suffix:
Gender:M
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GREAT MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-3823
Mailing Address - Country:US
Mailing Address - Phone:401-692-0800
Mailing Address - Fax:
Practice Address - Street 1:CHARLTON MEMORIAL HOSPITAL
Practice Address - Street 2:363 HIGHLAND AVE
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-679-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner