Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD074337 | PA |
NPI | 1245291657 |
---|---|
Provider Name | Kevin Michael Walsh |
First Address | Bryn Mawr, PA 19010-3838 |
Second Address | Bryn Mawr, PA 19010-3838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 26/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H66662 | (02) | PA |