Provider Demographics
NPI:1093850737
Name:WALSH, MARK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:106 MILFORD ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6962
Mailing Address - Country:US
Mailing Address - Phone:410-677-6500
Mailing Address - Fax:410-677-6502
Practice Address - Street 1:106 MILFORD ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6962
Practice Address - Country:US
Practice Address - Phone:410-677-6500
Practice Address - Fax:410-677-6502
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00462372084P0800X
SC163292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD161811300Medicaid
359054OtherMAMSI MDIPA
MD9753OtherCAREFIRST BC BS
522172306OtherTRICARE
359054OtherMAMSI MDIPA
MD9753OtherCAREFIRST BC BS