Provider Demographics
NPI:1720133655
Name:GOLDWATER, WALTER EUGENE (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:EUGENE
Last Name:GOLDWATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FOREST EDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1533
Mailing Address - Country:US
Mailing Address - Phone:413-549-7990
Mailing Address - Fax:
Practice Address - Street 1:108 RUSSEL ST
Practice Address - Street 2:
Practice Address - City:HADLEN
Practice Address - State:MA
Practice Address - Zip Code:01035-9546
Practice Address - Country:US
Practice Address - Phone:413-549-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43014103TP0814X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0149934Medicaid
A55215Medicare UPIN