MEDICARE: RALPH GERALD WALTON M.D.

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	2084P0800X	Psychiatry Physician	MD425467	PA
2	2084P0800X	Psychiatry Physician	101395	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	131177-000	OTHER	MAGELLAN
3	105497	OTHER	HIGHMARK PAR W/ PREMIER
4	00105497	OTHER	HIGHMARK KHPW
5	028625	OTHER	VALUEOPTIONS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952384844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH GERALD WALTON M.D.

Provider Business Mailing Address
First Line	:	95 EAST CHAUTAUQUA STREET
Second Line	:	PO BOX 168
City	:	MAYVILLE
State	:	NY
Zip	:	14757-0168
Country	:	US
Telephone Number	:	716-753-7107
Fax Number	:	716-753-5367

Provider Business Practice Location Address
First Line	:	95 EAST CHAUTAUQUA STREET
Second Line	:
City	:	MAYVILLE
State	:	NY
Zip	:	14757-0168
Country	:	US
Telephone Number	:	716-753-7107
Fax Number	:	716-753-5367

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	02/29/2012

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