Provider Demographics
NPI:1841852399
Name:MARK P WALSH DO LLC
Entity type:Organization
Organization Name:MARK P WALSH DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-346-3297
Mailing Address - Street 1:619 N GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-1813
Mailing Address - Country:US
Mailing Address - Phone:570-346-3297
Mailing Address - Fax:
Practice Address - Street 1:1623 MORGANTOWN RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-9455
Practice Address - Country:US
Practice Address - Phone:610-796-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation