Provider Demographics
NPI:1417727140
Name:WALSH, CALEB PATRICK
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:PATRICK
Last Name:WALSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 RUMER STA
Mailing Address - Street 2:
Mailing Address - City:RED HOUSE
Mailing Address - State:WV
Mailing Address - Zip Code:25168-6807
Mailing Address - Country:US
Mailing Address - Phone:304-951-8889
Mailing Address - Fax:
Practice Address - Street 1:290 RUMER STA
Practice Address - Street 2:
Practice Address - City:RED HOUSE
Practice Address - State:WV
Practice Address - Zip Code:25168-6807
Practice Address - Country:US
Practice Address - Phone:304-951-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant