MEDICARE: DR. WALTER RONALD SECOSKY DDS, MS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	1305	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	185482	OTHER	NC	UNITED CONCORDIA

General Provider Information

NPI Number	:	1437257714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER RONALD SECOSKY DDS, MS

Provider Business Mailing Address
First Line	:	604 MCCARTHY BLVD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5231
Country	:	US
Telephone Number	:	252-638-6177
Fax Number	:	252-638-5269

Provider Business Practice Location Address
First Line	:	604 MCCARTHY BLVD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5231
Country	:	US
Telephone Number	:	252-638-6177
Fax Number	:	252-638-5269

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/09/2007

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