Healthcare Provider Details

I. General information

NPI: 1720054893
Provider Name (Legal Business Name): VIRGINIA L. WALTERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOCUST ST
NORTHAMPTON MA
01060-2052
US

IV. Provider business mailing address

291 MOODY ST
LUDLOW MA
01056-1246
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-2175
  • Fax: 413-582-2954
Mailing address:
  • Phone: 866-390-1815
  • Fax: 770-666-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number55152
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: