Provider Demographics
NPI:1902849722
Name:WALSH, HUGH GYLNN (MD)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:GYLNN
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:455 OCONNOR DRIVE
Mailing Address - Street 2:#370
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-297-5775
Mailing Address - Fax:408-297-5783
Practice Address - Street 1:455 OCONNOR DRIVE
Practice Address - Street 2:#370
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-297-5775
Practice Address - Fax:408-297-5783
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG17606208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A40128Medicare UPIN