Provider Demographics
NPI:1033306121
Name:CHARLES BRUCE WALSH, M.D. LLP
Entity Type:Organization
Organization Name:CHARLES BRUCE WALSH, M.D. LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL-MCLANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-636-3373
Mailing Address - Street 1:140 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4915
Mailing Address - Country:US
Mailing Address - Phone:914-636-3373
Mailing Address - Fax:914-636-8726
Practice Address - Street 1:140 LOCKWOOD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4915
Practice Address - Country:US
Practice Address - Phone:914-636-3373
Practice Address - Fax:914-636-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145593-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0722H1OtherBCBS HOSPITAL
NY2473422002OtherCIGNA
NY280733POtherHIP
NY1447296OtherPHCS
NYMAGNACAREOther11303
NY0D2758OtherHEALTHNET
20041170OtherRAIL ROAD MEDICARE
NY01019314Medicaid
413191OtherUNITED HEALTHCARE
NY4653869OtherAETNA
NY0722H2OtherBCBS OFFICE
NY217377POtherHIP
NYWS807OtherOXFORD
NY4653869OtherAETNA
NY4653869OtherAETNA
NYWEJ871Medicare PIN