Provider Demographics
NPI:1699747246
Name:WALSH, MARY P (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:WALSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1849
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-5363
Practice Address - Street 1:43 SOKOKIS TRAIL
Practice Address - Street 2:
Practice Address - City:EAST WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04030
Practice Address - Country:US
Practice Address - Phone:207-247-6742
Practice Address - Fax:207-247-6114
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME1532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME270380099Medicaid
ME000216065Medicare PIN