Provider Demographics
NPI:1811903875
Name:WALKER, ALLAN R (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:R
Last Name:WALKER
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 1:120 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1931
Mailing Address - Country:US
Mailing Address - Phone:315-331-9537
Mailing Address - Fax:
Practice Address - Street 1:120 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1931
Practice Address - Country:US
Practice Address - Phone:315-331-9537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY97916208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00446295Medicaid
D01581Medicare UPIN
NY00446295Medicaid