Provider Demographics
NPI:1477717940
Name:WALSH, MAUREEN ANNE (PA)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3485 E TREMONT AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2016
Mailing Address - Country:US
Mailing Address - Phone:718-828-1549
Mailing Address - Fax:718-828-5029
Practice Address - Street 1:3485 E TREMONT AVE STE 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2016
Practice Address - Country:US
Practice Address - Phone:718-828-1549
Practice Address - Fax:718-828-5049
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant