=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083675573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN MARIE WALSH DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2006
-----------------------------------------------------
Last Update Date | 12/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SOUTH SHORE HEALTH 55 FOGG ROAD
-----------------------------------------------------
City | WEYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02190-2432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-322-5252
-----------------------------------------------------
Fax | 617-322-5252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 103
-----------------------------------------------------
City | READVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02137-0103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-322-5252
-----------------------------------------------------
Fax | 617-322-5252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 2182
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PD2182
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------