Provider Demographics
NPI:1205127818
Name:WALTER, SCOTT DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DANIEL
Last Name:WALTER
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 1:191 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3574
Mailing Address - Country:US
Mailing Address - Phone:860-646-7704
Mailing Address - Fax:860-647-7340
Practice Address - Street 1:191 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3574
Practice Address - Country:US
Practice Address - Phone:860-646-7704
Practice Address - Fax:860-647-7340
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56701207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist