Provider Demographics
NPI:1477534766
Name:WALTHER, ZENTA (MD PHD)
Entity Type:Individual
Prefix:
First Name:ZENTA
Middle Name:
Last Name:WALTHER
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:YNHH EAST PAVILION, ROOM 2-631
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-785-2788
Mailing Address - Fax:203-785-7146
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHH EAST PAVILION, ROOM 2-631
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-2788
Practice Address - Fax:203-785-7146
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039272207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001392729Medicaid
H42096Medicare UPIN
CT001392729Medicaid