Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | LO147 | OH |
N | 222Z00000X | Podiatrist | LO147 | OH |
Y | 224P00000X | Prosthetist | LP133 | OH |
NPI | 1306846209 |
---|---|
Provider Name | Thomas L Walsh |
First Address | Cincinnati, OH 45247-7007 |
Second Address | Cincinnati, OH 45247-7007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 03/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000000004 | ANTHEM PROVIDER NUMBER (01) | OH |
0101795 | (05) | OH |
200109890A | (05) | IN |
2067978 | AETNA PROVIDER NUMBER (01) | OH |
5348349 | CIGNA PROVIDER NUMBER (01) | OH |
90003468 | (05) | KY |