Provider Demographics
NPI:1982682167
Name:WALTHER, THOMAS ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:WALTHER
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 1:601 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5014
Mailing Address - Country:US
Mailing Address - Phone:304-797-6595
Mailing Address - Fax:304-797-6052
Practice Address - Street 1:380 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2667
Practice Address - Country:US
Practice Address - Phone:740-283-7246
Practice Address - Fax:740-283-7109
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058833207L00000X
OH35058833208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0070745990003Medicaid
WVP00819999OtherRR MEDICARE
OH0791040Medicaid
WV1806064000Medicaid
PA0070745990003Medicaid
OH4096063Medicare PIN
PA4096061Medicare PIN
E82821Medicare UPIN
OH4096062Medicare PIN