Provider Demographics
NPI:1972513356
Name:TILLMAN, WALTER THOMAS III (BCO)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:THOMAS
Last Name:TILLMAN
Suffix:III
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 LYTLE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2755
Mailing Address - Country:US
Mailing Address - Phone:412-283-4961
Mailing Address - Fax:412-283-4962
Practice Address - Street 1:2414 LYTLE RD STE 202
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2755
Practice Address - Country:US
Practice Address - Phone:412-283-4961
Practice Address - Fax:412-283-4962
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist