MEDICARE: RACHEL MARIE WALSH PA-C

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	363AM0700X	Medical Physician Assistant	MA052525	PA

General Provider Information

NPI Number	:	1891746582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARIE WALSH PA-C

Provider Business Mailing Address
First Line	:	3998 RED LION RD
Second Line	:	STE 250
City	:	PHILA
State	:	PA
Zip	:	19114
Country	:	US
Telephone Number	:	215-612-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3998 RED LION RD
Second Line	:	STE 250
City	:	PHILA
State	:	PA
Zip	:	19114
Country	:	US
Telephone Number	:	215-612-8500
Fax Number	:

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	02/25/2013

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