Provider Demographics
NPI:1295999191
Name:WALSH, KRISTIN MARIE (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 PARK CENTER DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6254
Mailing Address - Country:US
Mailing Address - Phone:407-297-3626
Mailing Address - Fax:912-338-7113
Practice Address - Street 1:1781 PARK CENTER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6254
Practice Address - Country:US
Practice Address - Phone:407-297-3626
Practice Address - Fax:912-338-7113
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 105120207R00000X
GA68019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine