MEDICARE: THOMAS H WALTER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	P00337	CT
2	213E00000X	Podiatrist	DPM00211	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	059393001	OTHER	CT	DMERC

General Provider Information

NPI Number	:	1457317190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS H WALTER DPM

Provider Business Mailing Address
First Line	:	145 LIBERTY ST
Second Line	:
City	:	PAWCATUCK
State	:	CT
Zip	:	06379-1538
Country	:	US
Telephone Number	:	860-599-4555
Fax Number	:	860-599-1394

Provider Business Practice Location Address
First Line	:	145 LIBERTY ST
Second Line	:
City	:	PAWCATUCK
State	:	CT
Zip	:	06379-1538
Country	:	US
Telephone Number	:	860-599-4555
Fax Number	:	860-599-1394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	04/04/2011

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Directions to “ THOMAS H WALTER DPM” Practice Location

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