Healthcare Provider Details

I. General information

NPI: 1417072745
Provider Name (Legal Business Name): STEPHANIE HUNT WALSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

IV. Provider business mailing address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 410-787-4627
  • Fax: 410-595-1994
Mailing address:
  • Phone: 410-938-3464
  • Fax: 410-938-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0064612
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: