Provider Demographics
NPI:1356303325
Name:WALTERS, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:WALTERS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6 NORTHWESTERN DR
Mailing Address - Street 2:SUITE # 305
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3463
Mailing Address - Country:US
Mailing Address - Phone:860-242-8591
Mailing Address - Fax:860-242-2511
Practice Address - Street 1:6 NORTHWESTERN DR
Practice Address - Street 2:SUITE # 305
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3463
Practice Address - Country:US
Practice Address - Phone:860-242-8591
Practice Address - Fax:860-242-2511
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-09-10
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Provider Licenses
StateLicense IDTaxonomies
CT023591208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001235910Medicaid
CT001235910Medicaid
CT1356303325Medicare Oscar/Certification