Provider Demographics
NPI:1720054893
Name:WALTERS, VIRGINIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:L
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:291 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1246
Mailing Address - Country:US
Mailing Address - Phone:866-390-1815
Mailing Address - Fax:770-666-9450
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2175
Practice Address - Fax:413-582-2954
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA55152207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8095528OtherCIGNA
MA114330OtherBOSTON MEDICAL CENTER HEALTHNET
MA1720054893OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MA1720054893OtherTRICARE/CHAMPUS
MAAA204044OtherHARVARD PILGRIM HEALTH PLAN
MA110043667AMedicaid
MA155152OtherCONNECTICARE
MA51122OtherHEALTH NEW ENGLAND
MA762995OtherTUFTS HEALTH PLAN
MA1720054893OtherFALLON COMMUNITY HEALTH PLAN
MA4260599OtherAETNA
MA1720054893OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MA51122OtherHEALTH NEW ENGLAND