Provider Demographics
NPI:1356320758
Name:O'DONNELL, WALTER JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JOSEPH
Last Name:O'DONNELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-9112
Mailing Address - Fax:617-643-2874
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:PULMONARY AND CRITICAL CARE COX2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-9112
Practice Address - Fax:617-643-2874
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2014-05-05
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Provider Licenses
StateLicense IDTaxonomies
MA59532207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA730121OtherTUFTS HEALTH PLAN
MAJ13081OtherBCBS MA
MA3080650Medicaid
F41378Medicare UPIN
MAJ13081OtherBCBS MA