MEDICARE: MRS. KATHRYN G WALTER

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	174400000X	Specialist

General Provider Information

NPI Number	:	1528407558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN G WALTER

Provider Business Mailing Address
First Line	:	14 ROLLING HILLS RD
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12309-1926
Country	:	US
Telephone Number	:	518-461-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 ROLLING HILLS RD
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12309-1926
Country	:	US
Telephone Number	:	518-456-8469
Fax Number	:

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

Provider Enumeration Date	:	06/24/2013
Last Update Date	:	10/17/2014

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