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General NPI Number Information
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NPI Number | 1770762650
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Entity Type | Individual
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Provider Name | BRENDAN COLLERAN WALSH M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE E31
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-0263
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 W 9TH ST APT 654
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City | CLEVELAND
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State | OH
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Zip | 44113-1031
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Country | US
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Telephone | 314-616-3823
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 57.009634
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License Number State | OH
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