Provider Demographics
NPI:1942250576
Name:WALSH, ROBERT DUPRE (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DUPRE
Last Name:WALSH
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:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-3235
Mailing Address - Country:US
Mailing Address - Phone:631-765-6976
Mailing Address - Fax:631-765-1589
Practice Address - Street 1:1265 FULTON AVENUE
Practice Address - Street 2:BRONX LEBENON SPECIAL CARE CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3401
Practice Address - Country:US
Practice Address - Phone:718-579-7060
Practice Address - Fax:718-579-7417
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187124207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01440922Medicaid
F61783Medicare UPIN
NY75H463Medicare ID - Type Unspecified