Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 2182 | MA |
NPI | 1083675573 |
---|---|
Provider Name | Susan M Walsh |
First Address | Milton, MA 02186-3621 |
Second Address | Milton, MA 02186-3621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2006 |
Last Update Date | 15/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110024958A | (05) | MA |
U85582 | (02) | MA |