Provider Demographics
NPI:1679645725
Name:WALSH, PATRICIA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARY
Last Name:WALSH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:22 BRADFORD ST
Mailing Address - Street 2:#1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2119
Mailing Address - Country:US
Mailing Address - Phone:617-542-7879
Mailing Address - Fax:781-477-3897
Practice Address - Street 1:500 LYNNFIELD ST
Practice Address - Street 2:E-3
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-1424
Practice Address - Country:US
Practice Address - Phone:781-477-3120
Practice Address - Fax:781-477-3897
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA603882084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1001523Medicaid
MAE86484Medicare UPIN
MAJ11181Medicare ID - Type Unspecified