Healthcare Provider Details

I. General information

NPI: 1093850737
Provider Name (Legal Business Name): MARK DAVID WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD ST SUITE 306
SALISBURY MD
21804-6962
US

IV. Provider business mailing address

106 MILFORD ST SUITE 306
SALISBURY MD
21804-6962
US

V. Phone/Fax

Practice location:
  • Phone: 410-677-6500
  • Fax: 410-677-6502
Mailing address:
  • Phone: 410-677-6500
  • Fax: 410-677-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0046237
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16329
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: