Provider Demographics
NPI:1013906395
Name:GREENHALGH, WALTER MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:MARK
Last Name:GREENHALGH
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:PSC 819
Mailing Address - Street 2:BOX 18
Mailing Address - City:FPO AE
Mailing Address - State:NY
Mailing Address - Zip Code:09645
Mailing Address - Country:ES
Mailing Address - Phone:0113495-682-3438
Mailing Address - Fax:
Practice Address - Street 1:PSC 819
Practice Address - Street 2:BOX 18
Practice Address - City:FPO AE
Practice Address - State:NY
Practice Address - Zip Code:09645
Practice Address - Country:ES
Practice Address - Phone:0113495-682-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine