Provider Demographics
NPI:1083740344
Name:STANLEY R WALKER MDPC
Entity Type:Organization
Organization Name:STANLEY R WALKER MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-252-0962
Mailing Address - Street 1:21 CORPORATE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2664
Mailing Address - Country:US
Mailing Address - Phone:610-252-0962
Mailing Address - Fax:610-252-4060
Practice Address - Street 1:21 CORPORATE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2664
Practice Address - Country:US
Practice Address - Phone:610-252-0962
Practice Address - Fax:610-252-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036484L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02298300OtherCAPITAL BLUE CROSS
PAA13191OtherAMERIHEALTH
PA0868276OtherAETNA
NJ087259OtherEMPIRE
PA0006493720003Medicaid
PA000000319438OtherANTHEM
0000113191OtherINDEPENDENCE BLUE CROSS B
PAA13191OtherAMERIHEALTH
PA02298300OtherCAPITAL BLUE CROSS
NJ087259OtherEMPIRE
PAC30502Medicare UPIN