Provider Demographics
NPI:1023032927
Name:WALDER, ERICH W (MD)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:W
Last Name:WALDER
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 714570
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4570
Mailing Address - Country:US
Mailing Address - Phone:513-791-4490
Mailing Address - Fax:513-791-7287
Practice Address - Street 1:4760 E GALBRAITH RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6703
Practice Address - Country:US
Practice Address - Phone:513-791-4490
Practice Address - Fax:513-791-7287
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077946207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWA4127432OtherMEDICARE
OH2360494Medicaid
OH2360494Medicaid