Provider Demographics
NPI:1053490458
Name:WALSH-PHILIP, JOAN THERESA (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:THERESA
Last Name:WALSH-PHILIP
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 LORD STERLING RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1338
Mailing Address - Country:US
Mailing Address - Phone:215-493-0784
Mailing Address - Fax:
Practice Address - Street 1:1226 LORD STERLING RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1338
Practice Address - Country:US
Practice Address - Phone:215-493-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002793L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA145426OtherPABS
PA145426Medicare ID - Type Unspecified
PA145426OtherPABS