Provider Demographics
NPI:1073508610
Name:WALSH, CAROLYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:703-723-7713
Mailing Address - Fax:703-723-7771
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-723-7713
Practice Address - Fax:703-723-7714
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101232633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110008498Medicare ID - Type Unspecified
F73395Medicare UPIN