Provider Demographics
NPI:1750491932
Name:WALSH, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3120
Mailing Address - Fax:812-242-3846
Practice Address - Street 1:221 S 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4214
Practice Address - Country:US
Practice Address - Phone:812-242-3120
Practice Address - Fax:812-242-3846
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029028A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01430OtherCIGNA
IN100251010Medicaid
N288167OtherHARMONY HEALTH PLAN IND
INP00834930OtherRAILROAD MEDICARE
0182878OtherUS DEPT OF LABOR
IN100251010AOtherMOLINA HEALTHCARE MCAID
273498OtherHEALTHLINK
I018482C003OtherUNISYS CHAMPUS SECONDARY
080061676OtherRAILROAD MCARE PALAMETTO
000000089628OtherANTHEM
4062104OtherAETNA
080061676OtherRAILROAD MCARE PALAMETTO
I018482C003OtherUNISYS CHAMPUS SECONDARY
4062104OtherAETNA
N288167OtherHARMONY HEALTH PLAN IND