Healthcare Provider Details

I. General information

NPI: 1720022528
Provider Name (Legal Business Name): BRIAN WALSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MORRISTOWN MEMORIAL HOSPITAL (EMERGENCY DEPARTMENT) 100 MADISON AVENUE
MORRISTOWN NJ
07960
US

IV. Provider business mailing address

PO BOX 717
LIVINGSTON NJ
07039-0717
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-5000
  • Fax:
Mailing address:
  • Phone: 973-740-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA07819800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: