Healthcare Provider Details

I. General information

NPI: 1265425474
Provider Name (Legal Business Name): SUSAN W WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST DEPARTMENT OF ANESTHESIA
PAWTUCKET RI
02860-4400
US

IV. Provider business mailing address

200 MAIN ST SUITE 350
PAWTUCKET RI
02860-4119
US

V. Phone/Fax

Practice location:
  • Phone: 401-726-7300
  • Fax: 401-726-7330
Mailing address:
  • Phone: 401-726-7300
  • Fax: 401-726-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD08744
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: