Provider Demographics
NPI:1891836573
Name:WALTERS, CLOVA (MD)
Entity Type:Individual
Prefix:
First Name:CLOVA
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:PO BOX 4240
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-4240
Mailing Address - Country:US
Mailing Address - Phone:484-432-6848
Mailing Address - Fax:888-416-1801
Practice Address - Street 1:865 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1935
Practice Address - Country:US
Practice Address - Phone:610-691-4357
Practice Address - Fax:484-221-9130
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040380-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE45224OtherAMERIHEALTH 65 COMPLETE
PA001175208Medicaid
PAE45224OtherMAGELLAN BEHAVIORAL HEALT
PA596189OtherGATEWAY 65 COMPLETE
PAE45224OtherAMERIHEALTH 65 COMPLETE