Healthcare Provider Details

I. General information

NPI: 1275500936
Provider Name (Legal Business Name): JOHN HENRY WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 TAMARACK AVE
SOUTH WINDSOR CT
06074-5562
US

IV. Provider business mailing address

2701 TAMARACK AVE
SOUTH WINDSOR CT
06074-5562
US

V. Phone/Fax

Practice location:
  • Phone: 860-647-8282
  • Fax: 860-647-8399
Mailing address:
  • Phone: 860-647-8282
  • Fax: 860-647-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number032177
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: