Healthcare Provider Details

I. General information

NPI: 1710275151
Provider Name (Legal Business Name): CHRISTOPHER PETER WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 HIGHWAY 9 E STE 200
LITTLE RIVER SC
29566-8164
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-390-0100
  • Fax: 843-390-0038
Mailing address:
  • Phone: 843-777-7092
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number51105
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number51105
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: