Provider Demographics
NPI:1114152543
Name:WALTER, ADAM C (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:WALTER
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 1:2105 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2644
Mailing Address - Country:US
Mailing Address - Phone:317-287-9238
Mailing Address - Fax:
Practice Address - Street 1:5308 HARROUN RD
Practice Address - Street 2:SUITE 280
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2193
Practice Address - Country:US
Practice Address - Phone:419-824-1785
Practice Address - Fax:419-824-5953
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35129292207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program