Healthcare Provider Details

I. General information

NPI: 1053385310
Provider Name (Legal Business Name): DAVID E WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FLAT ROCK PL 2ND FL
WESTBROOK CT
06498-1565
US

IV. Provider business mailing address

28 CRESCENT ST
MIDDLETOWN CT
06457-3654
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-3640
  • Fax: 860-358-8656
Mailing address:
  • Phone: 860-358-4820
  • Fax: 860-358-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number037987
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: