Provider Demographics
NPI:1508090549
Name:WALSH, TERESA M (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:M
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 1:3600 AOLELE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-3679
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 AOLELE ST
Practice Address - Street 2:PO BOX #29731
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96820-3679
Practice Address - Country:US
Practice Address - Phone:808-386-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.49206207V00000X
AK219639207V00000X
AZ74463207V00000X
TXP6107207V00000X
HIMD-20573207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology