Provider Demographics
NPI:1689625584
Name:WALTERS, BETH (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:WALTERS
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 1:6515 WATTS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2726
Mailing Address - Country:US
Mailing Address - Phone:608-238-5826
Mailing Address - Fax:608-238-1221
Practice Address - Street 1:6515 WATTS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2726
Practice Address - Country:US
Practice Address - Phone:608-238-5826
Practice Address - Fax:608-238-1221
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI258820202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30632700Medicaid
E16115Medicare UPIN
WI30632700Medicaid