MEDICARE: SARAH WALSH

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	174400000X	Specialist	0119006235	VA

General Provider Information

NPI Number	:	1760888598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH WALSH

Provider Business Mailing Address
First Line	:	1301 S CLEVELAND ST APT 357
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4872
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 S CLEVELAND ST APT 357
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4872
Country	:	US
Telephone Number	:	410-991-5591
Fax Number	:

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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