Provider Demographics
NPI:1346437159
Name:WALSH, ROGER N (MD, PHD)
Entity Type:Individual
Prefix:PROF
First Name:ROGER
Middle Name:N
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF CALIFORNIA MEDICAL SCHOOL
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-1675
Mailing Address - Country:US
Mailing Address - Phone:949-824-6604
Mailing Address - Fax:866-792-5306
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA MEDICAL SCHOOL
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-1675
Practice Address - Country:US
Practice Address - Phone:949-824-6604
Practice Address - Fax:866-792-5306
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA258702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry