Provider Demographics
NPI:1972680494
Name:WALKER, GREGORY A (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:189 PROUTY DR
Mailing Address - Street 2:MEDICAL ARTS BUILDING
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9326
Mailing Address - Country:US
Mailing Address - Phone:802-334-3569
Mailing Address - Fax:802-334-4134
Practice Address - Street 1:189 PROUTY DR
Practice Address - Street 2:MEDICAL ARTS BUILDING
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9326
Practice Address - Country:US
Practice Address - Phone:802-334-3569
Practice Address - Fax:802-334-4134
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009224207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30202221Medicaid
VT0VN1251Medicaid
VT350841OtherMVP
VT00028549OtherBLUE SHIELD
VT0VN1251Medicaid
VT00028549OtherBLUE SHIELD