Healthcare Provider Details

I. General information

NPI: 1972824076
Provider Name (Legal Business Name): JOHN CHRISTOPHER WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2010
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PURPLE HEART AVE
DOVER DE
19902-5051
US

IV. Provider business mailing address

NAVAL HOSPITAL JACKSONVILLE DEPT OF FAMILY 2080 CHILD STREET
JACKSONVILLE FL
32214-0001
US

V. Phone/Fax

Practice location:
  • Phone: 302-346-8648
  • Fax:
Mailing address:
  • Phone: 907-542-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number0101250648
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: