1396845384 NPI number — DR. CHARLES A WALCH M.D., F.A.C.S.

Table of content: DR. CHARLES A WALCH M.D., F.A.C.S. (NPI 1396845384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396845384 NPI number — DR. CHARLES A WALCH M.D., F.A.C.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALCH
Provider First Name:
CHARLES
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., F.A.C.S.
Provider Gender Code:
M

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:
1396845384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 NORTH 4TH STREET
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21550-1395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-334-8282
Provider Business Mailing Address Fax Number:
301-334-8468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 NORTH 4TH STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21550-1395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-334-8282
Provider Business Practice Location Address Fax Number:
301-334-8468
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  D47925 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020027593 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 413716 . This is a "BC/S" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 236009 . This is a "PEIA/ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53574001 . This is a "CAREFIRST BC/S" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205900200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 521113778001 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521113778011 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 022247700 . This is a "DC MEDICAID" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 521113778 . This is a "4 MOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: H814GA . This is a "BC/S" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1395892 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260066 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: S3300002 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 236009 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001708716 . This is a "MT. STATE BC/S" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0126344000 . This is a "DPA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 330396 . This is a "TRIGON BC/S" identifier . This identifiers is of the category "OTHER".




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