Provider Demographics
NPI:1003856469
Name:WALSH, BETH ANNE HICKS (PAC)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE HICKS
Last Name:WALSH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 WASHINGTON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5779
Mailing Address - Country:US
Mailing Address - Phone:410-848-2444
Mailing Address - Fax:410-857-1634
Practice Address - Street 1:826 WASHINGTON RD STE 120
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5779
Practice Address - Country:US
Practice Address - Phone:410-848-2444
Practice Address - Fax:410-857-1634
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002057363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2638822OtherUNITED HEALTHCARE
MD234963YBDBMedicare PIN
MD0TH00Medicare UPIN