Provider Demographics
NPI:1932187515
Name:WALTER, JOHN A (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:WALTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:2384 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1637
Practice Address - Country:US
Practice Address - Phone:740-689-4935
Practice Address - Fax:740-689-4889
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0078402081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00140797OtherRAILROAD MEDICARE
OH7162600OtherAETNA
OH2300943OtherUNITEDHEALTHCARE
OH000000335626OtherANTHEM BC/BS
OH2491825Medicaid
OH311639119029OtherCARESOURCE MEDICAID
OH0761750OtherCIGNA
OHP00140797OtherRAILROAD MEDICARE
OHI11893Medicare UPIN
OHH370700Medicare PIN