Healthcare Provider Details

I. General information

NPI: 1982682167
Provider Name (Legal Business Name): THOMAS ROBERT WALTHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SUMMIT AVE
STEUBENVILLE OH
43952-2667
US

IV. Provider business mailing address

601 COLLIERS WAY
WEIRTON WV
26062-5014
US

V. Phone/Fax

Practice location:
  • Phone: 740-283-7246
  • Fax: 740-283-7109
Mailing address:
  • Phone: 304-797-6595
  • Fax: 304-797-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35-058833
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35058833
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: