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General NPI Number Information
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NPI Number | 1871584516
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Entity Type | Individual
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Provider Name | JENNIFER GEORGE WALSH M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1540 MAPLE RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3647
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Country | US
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Telephone | 716-830-1657
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Fax |
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Provider Business Mailing Address
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Address Line | 639 E GOUNDRY ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-5620
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Country | US
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Telephone | 716-830-1657
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 217709
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License Number State | NY
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