Provider Demographics
NPI:1952397853
Name:WALTERS, DANIEL HUGH (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:HUGH
Last Name:WALTERS
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 BURNS AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4316
Mailing Address - Country:US
Mailing Address - Phone:513-761-4409
Mailing Address - Fax:
Practice Address - Street 1:8859 BROOKSIDE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7113
Practice Address - Country:US
Practice Address - Phone:513-779-6225
Practice Address - Fax:513-779-6905
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052659W207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0777575Medicaid
OHE37096Medicare UPIN
OHWA0656455Medicare ID - Type Unspecified