MEDICARE: MR. ROBERT DUPRE WALSH 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
1	207RI0200X	Infectious Disease Physician	187124	NY

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

General Provider Information

NPI Number	:	1942250576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT DUPRE WALSH MD

Provider Business Mailing Address
First Line	:	PO BOX 1349
Second Line	:
City	:	SOUTHOLD
State	:	NY
Zip	:	11971-3235
Country	:	US
Telephone Number	:	631-765-6976
Fax Number	:	631-765-1589

Provider Business Practice Location Address
First Line	:	1265 FULTON AVENUE
Second Line	:	BRONX LEBENON SPECIAL CARE CENTER
City	:	BRONX
State	:	NY
Zip	:	10456-3401
Country	:	US
Telephone Number	:	718-579-7060
Fax Number	:	718-579-7417

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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