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General NPI Number Information
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NPI Number | 1295999191
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Entity Type | Individual
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Provider Name | KRISTIN MARIE WALSH MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 1781 PARK CENTER DR SUITE 120
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City | ORLANDO
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State | FL
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Zip | 32835-6254
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Country | US
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Telephone | 407-297-3626
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Fax | 912-338-7113
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Provider Business Mailing Address
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Address Line | 1781 PARK CENTER DR SUITE 120
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City | ORLANDO
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State | FL
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Zip | 32835-6254
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Country | US
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Telephone | 407-297-3626
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Fax | 912-338-7113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 105120
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 68019
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License Number State | GA
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