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NPI Code Detail

MEDICARE: ELLIOT WALTERS MD

MEDICARE: ELLIOT WALTERS MD
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
12086S0102XSurgical Critical Care PhysicianMD486109PA

General Provider Information

NPI Number : 1477973592
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIOT WALTERS MD
Provider Business Mailing Address
First Line : 3509 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-4105
Country : US
Telephone Number : 215-707-2433
Fax Number :
Provider Business Practice Location Address
First Line : 3401 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5189
Country : US
Telephone Number : 215-707-3133
Fax Number : 215-707-3945
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2014
Last Update Date : 01/22/2026

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