Healthcare Provider Details

I. General information

NPI: 1659366631
Provider Name (Legal Business Name): LINDA AHLQUIST WALSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 NORRISVILLE RD SUITE C
JARRETTSVILLE MD
21084-1419
US

IV. Provider business mailing address

3718 NORRISVILLE RD SUITE C
JARRETTSVILLE MD
21084-1419
US

V. Phone/Fax

Practice location:
  • Phone: 410-692-5292
  • Fax: 410-557-4256
Mailing address:
  • Phone: 410-692-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0034208
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: