Provider Demographics
NPI:1477505188
Name:WALSH, GLYNIS A (MD)
Entity Type:Individual
Prefix:
First Name:GLYNIS
Middle Name:A
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 W END AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1605
Mailing Address - Country:US
Mailing Address - Phone:203-344-1982
Mailing Address - Fax:
Practice Address - Street 1:34 MAPLE STREET
Practice Address - Street 2:NORWALK HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06852
Practice Address - Country:US
Practice Address - Phone:203-852-2281
Practice Address - Fax:203-855-3705
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3864007Medicaid
TN3864008Medicare ID - Type Unspecified
TN3864007Medicaid