Healthcare Provider Details

I. General information

NPI: 1659379832
Provider Name (Legal Business Name): CHARLES BRUCE WALSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OSBORNE ST
DANBURY CT
06810
US

IV. Provider business mailing address

111 OSBORNE ST
DANBURY CT
06810-6000
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-7131
  • Fax: 203-739-1554
Mailing address:
  • Phone: 203-739-7131
  • Fax: 203-739-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number52627
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number52627
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: