Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MB021042 | NJ |
NPI | 1255366340 |
---|---|
Provider Name | Dr. Michael A. Walder |
First Address | Cherry Hill, NJ 08034-2714 |
Second Address | Cherry Hill, NJ 08002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 06/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1120701 | (05) | NJ |
D07037 | (02) | NJ |