Provider Demographics
NPI:1063499655
Name:WALTERS, TORIN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:TORIN
Middle Name:PATRICK
Last Name:WALTERS
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:3448 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2906
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY316162085R0202X
OH35-08-0613-W2085R0202X
WV177222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000195382OtherUNISON
OH0974950Medicaid
4529733OtherAETNA
KY50007255OtherPASSPORT
KY6470037000Medicaid
000481091OtherMTN STATE BCBS
WV55049337600OtherWORKMANS COMP
WV0120318000Medicaid
WV940000040OtherRR MEDICARE (WV)
WV0762341Medicare PIN
4529733OtherAETNA
000481091OtherMTN STATE BCBS
F80953Medicare UPIN