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General NPI Number Information
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NPI Number | 1912329889
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Entity Type | Organization
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Legal Business Name | MARK D WALSH
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 7611 HIGHWAY 76 SUITE C
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City | PENDLETON
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State | SC
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Zip | 29670-9162
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Country | US
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Telephone | 864-546-5570
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Fax | 864-546-5571
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Provider Business Mailing Address
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Address Line | 7611 HIGHWAY 76 SUITE C
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City | PENDLETON
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State | SC
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Zip | 29670-9162
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Country | US
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Telephone | 864-546-5570
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Fax | 864-546-5571
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Authorized Official
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Title or Position | M.D. AND CEO
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Name | DR. MARK D WALSH
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Credential | MD
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Telephone | 864-653-0163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | SC
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