Provider Demographics
NPI:1649271180
Name:WALSH, JOHN R (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:WALSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WILLOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5576
Mailing Address - Country:US
Mailing Address - Phone:610-906-4770
Mailing Address - Fax:
Practice Address - Street 1:210 WILLOWBROOK LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5576
Practice Address - Country:US
Practice Address - Phone:610-696-8900
Practice Address - Fax:610-696-3890
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006953L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1294915Medicaid
660939 F6WMedicare ID - Type Unspecified
PA1294915Medicaid