Provider Demographics
NPI:1043214828
Name:WALSH, RICHARD PETER (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PETER
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 W WOOSTER ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2646
Mailing Address - Country:US
Mailing Address - Phone:419-353-6262
Mailing Address - Fax:419-353-6260
Practice Address - Street 1:960 W WOOSTER ST STE 105
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2646
Practice Address - Country:US
Practice Address - Phone:419-353-6262
Practice Address - Fax:419-353-6260
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0542416Medicaid
OH9341311Medicare ID - Type Unspecified
OH0542416Medicaid