Provider Demographics
NPI:1821077702
Name:SZPUR, WALTER BOHDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:BOHDAN
Last Name:SZPUR
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 1:200 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4500
Mailing Address - Country:US
Mailing Address - Phone:914-631-6563
Mailing Address - Fax:914-631-5611
Practice Address - Street 1:200 S BROADWAY
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4500
Practice Address - Country:US
Practice Address - Phone:914-631-6563
Practice Address - Fax:914-631-5611
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154301173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1051313OtherFIRST HEALTH
NY154301OtherHIP
NY891337OtherMVP
NY00816986Medicaid
NY7832OtherCOMMUNITY CHOICE
NY03781OtherGHI
NY1440OtherAFFINITY
NY229634OtherWORKERS COMPENSATION
NY13853OtherATLANTIS
NY38475OtherCIGNA
NYP469249OtherOXFORD
NY559468OtherAETNA
NYD3163OtherHEALTHNET
NYP469249OtherOXFORD
NYA60396Medicare UPIN