Provider Demographics
NPI:1669400891
Name:WALTERS, CHERYL ASHVILLE (M D)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ASHVILLE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:M D
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Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-696-0090
Mailing Address - Fax:860-696-0095
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 125
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-696-0090
Practice Address - Fax:860-696-0095
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT030738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669400891OtherNPI
1669400891OtherNPI