Provider Demographics
NPI:1124010954
Name:WALSH, EDWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:WALSH
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 1:1320 MERCY DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2614
Mailing Address - Country:US
Mailing Address - Phone:330-489-1278
Mailing Address - Fax:330-430-2778
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-489-1278
Practice Address - Fax:330-430-2778
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350590232085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000529637OtherANTHEM
OH000000224357OtherUNISON
OH2026695Medicaid
OH2326673OtherAETNA
OH364106OtherWELLCARE
OHP00445898OtherRAILROAD MEDICARE
OH732806OtherBUCKEYE
OH000000529637OtherANTHEM
OHWA4125973Medicare PIN
OHWA4125972Medicare PIN
OHP00445898OtherRAILROAD MEDICARE
OH2026695Medicaid