Provider Demographics
NPI:1497771141
Name:CHWALS, WALTER J (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:CHWALS
Suffix:
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 1:800 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-5000
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0808132086S0120X
MA547062086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000503637OtherANTHEM
OH000000204731OtherUNISON
PA1012234150001OtherPENNSYLVANIA MEDICAID
WV3810009981OtherWEST VIRGINIA MEDICAID
5904683OtherAETNA
OH363426OtherWELLCARE
OH2319539OtherBCMH
OH2319539Medicaid
OH734678OtherBUCKEYE
OH734678OtherBUCKEYE
OH2319539OtherBCMH
D92681Medicare UPIN