Provider Demographics
NPI:1578602991
Name:WALSH, AMY D (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:D
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 1:106 MILFORD ST.
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6462
Mailing Address - Country:US
Mailing Address - Phone:410-677-6500
Mailing Address - Fax:410-677-6502
Practice Address - Street 1:106 MILFORD ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6962
Practice Address - Country:US
Practice Address - Phone:410-677-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046137174400000X
MDD46137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD125151100Medicaid
MD199CAD 53266001OtherBCBS
E78805Medicare UPIN
MD455SMedicare ID - Type Unspecified
MD125151100Medicaid