Provider Demographics
NPI:1245543784
Name:WALSH, LEORAH MIRI (MD)
Entity type:Individual
Prefix:DR
First Name:LEORAH
Middle Name:MIRI
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4222 BALTIMORE AVE # 1F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4412
Mailing Address - Country:US
Mailing Address - Phone:215-307-5395
Mailing Address - Fax:
Practice Address - Street 1:100 E LEHIGH AVE
Practice Address - Street 2:EPISCOPAL HOSPITAL TEMPLE UNIVERSITY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125
Practice Address - Country:US
Practice Address - Phone:215-707-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1979242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry