Provider Demographics
NPI:1932161999
Name:WALHA, GURMUKH S (MD)
Entity Type:Individual
Prefix:DR
First Name:GURMUKH
Middle Name:S
Last Name:WALHA
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 1:542B WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4710
Mailing Address - Country:US
Mailing Address - Phone:336-629-4171
Mailing Address - Fax:336-629-4345
Practice Address - Street 1:542B WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4710
Practice Address - Country:US
Practice Address - Phone:336-629-4171
Practice Address - Fax:336-629-4345
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-23451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985249Medicaid
NC85249OtherBCBSNC
NCC89577Medicare UPIN
NC211233Medicare ID - Type Unspecified
NC8985249Medicaid