Provider Demographics
NPI:1922077056
Name:WALKER, PAUL A (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:WALKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 PENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1301
Mailing Address - Country:US
Mailing Address - Phone:609-883-4124
Mailing Address - Fax:609-883-1909
Practice Address - Street 1:1539 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-1301
Practice Address - Country:US
Practice Address - Phone:609-883-4124
Practice Address - Fax:609-883-1909
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05671800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5090601Medicaid
E91841Medicare UPIN
678998AQQMedicare ID - Type Unspecified