Provider Demographics
NPI:1912056029
Name:LINDA A WALSH MD PA
Entity type:Organization
Organization Name:LINDA A WALSH MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-692-5292
Mailing Address - Street 1:3718 NORRISVILLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1419
Mailing Address - Country:US
Mailing Address - Phone:410-692-5292
Mailing Address - Fax:410-557-4256
Practice Address - Street 1:3718 NORRISVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1419
Practice Address - Country:US
Practice Address - Phone:410-692-5292
Practice Address - Fax:410-557-4256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034208302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD891LMedicare ID - Type Unspecified
MD080159898Medicare PIN