Provider Demographics
NPI:1851327860
Name:WALSH, SIMONA (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMONA
Middle Name:
Last Name:WALSH
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 1:4870 YORK RD
Mailing Address - Street 2:PO BOX 665
Mailing Address - City:BUCKINGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18912-0665
Mailing Address - Country:US
Mailing Address - Phone:215-794-3305
Mailing Address - Fax:215-794-9642
Practice Address - Street 1:4870 YORK RD
Practice Address - Street 2:
Practice Address - City:BUCKINGHAM
Practice Address - State:PA
Practice Address - Zip Code:18912-0665
Practice Address - Country:US
Practice Address - Phone:215-794-3305
Practice Address - Fax:215-794-9642
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419441208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2099054000OtherAMERIHEALTH
PA1411988OtherHIGHMARK
PA2992535OtherAETNA