Provider Demographics
NPI:1306846209
Name:WALSH, THOMAS L
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:WALSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 CHEVIOT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7007
Mailing Address - Country:US
Mailing Address - Phone:513-245-0253
Mailing Address - Fax:513-245-0258
Practice Address - Street 1:5701 CHEVIOT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7007
Practice Address - Country:US
Practice Address - Phone:513-245-0253
Practice Address - Fax:513-245-0258
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLO147222Z00000X
OHLP133224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2067978OtherAETNA PROVIDER NUMBER
OH5348349OtherCIGNA PROVIDER NUMBER
KY90003468Medicaid
OH0101795Medicaid
IN200109890AMedicaid
OH000000000004OtherANTHEM PROVIDER NUMBER
OH0902660002Medicare NSC
KY90003468Medicaid
OH7360410002Medicare NSC
IN200109890AMedicaid