1508352048 NPI number — DR. JILLIAN PATRICIA WALSH MD.

Table of content: DR. JILLIAN PATRICIA WALSH MD. (NPI 1508352048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508352048 NPI number — DR. JILLIAN PATRICIA WALSH MD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
JILLIAN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD.
Provider Gender Code:
F

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:
1508352048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/13/2019
NPI Reactivation Date:
03/20/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BRIGHAM & WOMEN'S HOSPITAL, VASCULAR AND ENDOVASCULAR S
Provider Second Line Business Mailing Address:
75 FRANCIS ST.
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-307-1920
Provider Business Mailing Address Fax Number:
857-307-1922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CAPITAL WAY STE 356
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08534-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-537-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2018

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 25MA10923300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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