Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | D83190 | MD |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | D0083190 | MD |
NPI | 1174899645 |
---|---|
Provider Name | Cory Thomas Walsh |
First Address | Frederick, MD 21702-4348 |
Second Address | Frederick, MD 21702-4348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 14/06/2020 |