Provider Demographics
NPI:1093711145
Name:COX, WALTER R (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:R
Last Name:COX
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 1:1163 COUNTRY CLUB RD
Mailing Address - Street 2:LOMBARDI CENTER STE. 101
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1013
Mailing Address - Country:US
Mailing Address - Phone:724-258-2229
Mailing Address - Fax:
Practice Address - Street 1:1163 COUNTRY CLUB RD
Practice Address - Street 2:LOMBARDI CENTER STE. 101
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1013
Practice Address - Country:US
Practice Address - Phone:724-258-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039092E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1514263OtherGATEWAY HEALTH PLANS
PA0011941880003Medicaid
PA596008OtherHIGHMARK
PA116490OtherUNISON
PA596008Medicare PIN
PA0011941880003Medicaid