Provider Demographics
NPI:1083675573
Name:WALSH, SUSAN MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:WALSH
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:P.O. BOX 103
Mailing Address - Street 2:
Mailing Address - City:READVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02137-0103
Mailing Address - Country:US
Mailing Address - Phone:617-322-5252
Mailing Address - Fax:617-322-5252
Practice Address - Street 1:SOUTH SHORE HEALTH
Practice Address - Street 2:55 FOGG ROAD
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:617-322-5252
Practice Address - Fax:617-322-5252
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2182213ES0131X
MAPD2182213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110024958AMedicaid
MAU85582Medicare UPIN
MAY45840Medicare PIN