Provider Demographics
NPI:1699836676
Name:WALSH, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
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:PO BOX 8510
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-8510
Mailing Address - Country:US
Mailing Address - Phone:804-493-8880
Mailing Address - Fax:804-493-9993
Practice Address - Street 1:15394 KINGS HWY
Practice Address - Street 2:
Practice Address - City:MONTROSS
Practice Address - State:VA
Practice Address - Zip Code:22520-2746
Practice Address - Country:US
Practice Address - Phone:804-493-8880
Practice Address - Fax:804-493-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010441012085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA503970OtherNCPPO
VA211132OtherANTHEM BLUE CROSS VA
VA211132OtherANTHEM BLUE CROSS VA
VAE23091Medicare UPIN