Provider Demographics
NPI: | 1366480519 |
---|---|
Name: | BELL, WALTER JAMES JR (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | WALTER |
Middle Name: | JAMES |
Last Name: | BELL |
Suffix: | JR |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 820956 |
Mailing Address - Street 2: | TEMPLE PHYSICIANS INC |
Mailing Address - City: | PHILADELPHIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19182-0956 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-777-2455 |
Mailing Address - Fax: | 610-617-6280 |
Practice Address - Street 1: | 2301 E ALLEGHENY HOSPITAL |
Practice Address - Street 2: | NORTHWESTERN HOSPITAL |
Practice Address - City: | PHILADELPHIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19134 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-423-2376 |
Practice Address - Fax: | 215-634-4872 |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2006-06-02 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | OS008177L | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 791431 | Other | HIGHMARK BS |
PA | 0015548720008 | Medicaid | |
PA | 791431 | Medicare ID - Type Unspecified | |
PA | 0015548720008 | Medicaid |