Provider Demographics
NPI:1659363257
Name:WALSH, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:WALSH
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 1:113 RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:QUEENSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21658-1642
Mailing Address - Country:US
Mailing Address - Phone:410-353-4501
Mailing Address - Fax:
Practice Address - Street 1:113 RIVER RUN
Practice Address - Street 2:
Practice Address - City:QUEENSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21658-1642
Practice Address - Country:US
Practice Address - Phone:410-353-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0100062OtherAETNA CAPITATED BROADNECK
MD354504-05OtherCAREFIRST MD RENDERING KI
MD7605-0015OtherCAREFIRST BLUECHOICE
MD235423OtherMAMSI SPECIALIST BN
MD8114676OtherMAMSI PRIMARY CARE KI
MDP11963OtherCAREFIRST MPOS
MD0122983OtherCIGNA PIN
MD4088401OtherAETNA FEE FOR SERVICE
MD0100067OtherAETNA CAPITATED KENT IS.
MD2114676OtherMAMSI SPECIALIST KI
MD835423OtherMAMSI PRIMARY CARE BN
MD354504-01OtherCAREFIRST MD RENDERING BN
MD028700OtherJHHC PROVIDER NUMBER
MD769241200Medicaid
MD80083146OtherRR MEDICARE
MD028700OtherJHHC PROVIDER NUMBER
MD2114676OtherMAMSI SPECIALIST KI
MD8114676OtherMAMSI PRIMARY CARE KI