MEDICARE: BRYAN WALSH ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath

General Provider Information

NPI Number	:	1063717114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN WALSH ND

Provider Business Mailing Address
First Line	:	300 6TH AVENUE NE
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21060
Country	:	US
Telephone Number	:	443-458-8307
Fax Number	:	443-740-9220

Provider Business Practice Location Address
First Line	:	9055 CHEVROLET DR
Second Line	:	SUTIE 202
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4016
Country	:	US
Telephone Number	:	443-577-4115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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