Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD459550 | PA |
NPI | 1013233071 |
---|---|
Provider Name | Dr. Kevin Michael Walsh |
First Address | Monroeville, PA 15146-3518 |
Second Address | Monroeville, PA 15146-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103302821 | (05) | PA |
14011367 | CAQH (01) |