Healthcare Provider Details

I. General information

NPI: 1649356593
Provider Name (Legal Business Name): CHRISTINE A WALSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHAM 3415 BAINBRIDGE AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

PO BOX 238
DOUGLASTON NY
11363-0238
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2450
  • Fax:
Mailing address:
  • Phone: 718-741-2450
  • Fax: 718-944-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number123813
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: