Provider Demographics
NPI:1659379832
Name:WALSH, CHARLES BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRUCE
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 1:111 OSBORNE ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6000
Mailing Address - Country:US
Mailing Address - Phone:203-739-7131
Mailing Address - Fax:203-739-1554
Practice Address - Street 1:111 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-739-7131
Practice Address - Fax:203-739-1554
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52627208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0722HSOtherBCBS - HOSPITAL
1447298OtherPHCS
0722H2OtherBLUE CROSS BLUE SHIELD
0D2758OtherHEALTHNET (PHS)
4653869OtherAETNA/US HEALTHCARE
DO1464OtherHEALTHNET (PHS)
47-091121801Other1199
NY004858OtherCOMMUNITY CHOICE
NY1019314Medicaid
NY0722H1OtherBLUE CROSS BLUE SHIELD
WS807OtherOXFORD
NY145593OtherWORKER'S COMP.
413191OtherUNITED HEALTH
FLWEJ871OtherMEDICARE USPECIFIED
2473422002OtherCIGNA
146349OtherANTHEM BCBS
20041170OtherRR MEDICARE UHC
NY470911218OtherMAGNACARE
P00126373OtherRAILROAD MEDICARE
P00126373OtherRAILROAD MEDICARE