Provider Demographics
NPI:1407828098
Name:WALSH, STEPHEN R (MDCM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:WALSH
Suffix:
Gender:M
Credentials:MDCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-8881
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRJ 504, INFECTIOUS DISEASE UNIT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3812
Practice Address - Fax:617-726-7416
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205960207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22966OtherBCBS MA
MA205960OtherTUFTS HEALTH PLAN
MA0128724Medicaid
MA205960OtherTUFTS HEALTH PLAN
MA0128724Medicaid