1164505723 NPI number — DR. LYNN EDGAR WALSH D.C.

Table of content: DR. LYNN EDGAR WALSH D.C. (NPI 1164505723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164505723 NPI number — DR. LYNN EDGAR WALSH D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
LYNN
Provider Middle Name:
EDGAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1164505723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6028 OLD SHAWNEE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19963-3355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-422-0622
Provider Business Mailing Address Fax Number:
302-422-0520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 AIRPORT RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19963-6421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-422-0622
Provider Business Practice Location Address Fax Number:
302-422-0520
Provider Enumeration Date:
10/24/2006

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: 111N00000X , with the licence number:  F1-0000180 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MR- WA140158 . This is a "PROVIDER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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