Provider Demographics
NPI:1376616029
Name:NALESNIK, WALTER J JR (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:NALESNIK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BOSTON STREET
Mailing Address - Street 2:204
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904
Mailing Address - Country:US
Mailing Address - Phone:781-595-9581
Mailing Address - Fax:781-595-9628
Practice Address - Street 1:225 BOSTON STREET
Practice Address - Street 2:204
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904
Practice Address - Country:US
Practice Address - Phone:781-595-9581
Practice Address - Fax:781-595-9628
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS3680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
703505OtherTUFTS
65494OtherHPHC
9037OtherUS HEALTH
80744OtherFALLON
J04507OtherBCBS
0400048OtherUNITED
MA9705121Medicaid
B1002301OtherCIGNA
MA9705121Medicaid
MAC5127Medicare UPIN