Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | PT012868-L | PA |
NPI | 1629470828 |
---|---|
Provider Name | Dr. Matthew Marcus Walko |
First Address | Mechanicsburg, PA 17055-6170 |
Second Address | Annville, PA 17003-1319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2014 |
Last Update Date | 18/09/2014 |