Healthcare Provider Details

I. General information

NPI: 1649411901
Provider Name (Legal Business Name): JAMES PATRICK WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

172 STERLING PL APT 3
BROOKLYN NY
11217-3398
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-4446
  • Fax:
Mailing address:
  • Phone: 301-204-2790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number252047
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number252047
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: