Provider Demographics
NPI:1952384844
Name:WALTON, RALPH GERALD (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:GERALD
Last Name:WALTON
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 1:95 EAST CHAUTAUQUA STREET
Mailing Address - Street 2:PO BOX 168
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-0168
Mailing Address - Country:US
Mailing Address - Phone:716-753-7107
Mailing Address - Fax:716-753-5367
Practice Address - Street 1:95 EAST CHAUTAUQUA STREET
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:14757-0168
Practice Address - Country:US
Practice Address - Phone:716-753-7107
Practice Address - Fax:716-753-5367
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4254672084P0800X
NY1013952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00596016Medicaid
131177-000OtherMAGELLAN
105497OtherHIGHMARK PAR W/ PREMIER
00105497OtherHIGHMARK KHPW
028625OtherVALUEOPTIONS
PA0007940410005Medicaid
00105497OtherHIGHMARK KHPW
PA088048K19Medicare ID - Type Unspecified
028625OtherVALUEOPTIONS