Provider Demographics
NPI:1619937935
Name:WALKER, THOMAS N (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:N
Last Name:WALKER
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 1:327 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9006
Mailing Address - Country:US
Mailing Address - Phone:681-342-3461
Mailing Address - Fax:
Practice Address - Street 1:327 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9006
Practice Address - Country:US
Practice Address - Phone:681-342-1610
Practice Address - Fax:681-342-1626
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17721207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001713042OtherBCBS AAP NUMBER
WV0060749000Medicaid
WV205542387OtherAAP TRI CARE NUMBER
WV27005299701OtherBRICKSTREET
WV27005299701OtherBRICKSTREET
WVP00137179Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WV205542387OtherAAP TRI CARE NUMBER
WV0764393Medicare ID - Type UnspecifiedAAP MEDICARE NUMBER