1083740344 NPI number — STANLEY R WALKER MDPC

Table of content: (NPI 1083740344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083740344 NPI number — STANLEY R WALKER MDPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANLEY R WALKER MDPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083740344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 CORPORATE DR
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18045-2664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-252-0962
Provider Business Mailing Address Fax Number:
610-252-4060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 CORPORATE DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18045-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-252-0962
Provider Business Practice Location Address Fax Number:
610-252-4060
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-252-0962

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD036484L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02298300 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A13191 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0868276 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 087259 . This is a "EMPIRE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0006493720003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000319438 . This is a "ANTHEM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000113191 . This is a "INDEPENDENCE BLUE CROSS B" identifier . This identifiers is of the category "OTHER".




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