1700849940 NPI number — ALYSON MARIE WALSH PA-C

Table of content: ALYSON MARIE WALSH PA-C (NPI 1700849940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700849940 NPI number — ALYSON MARIE WALSH PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
ALYSON
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMES
Provider Other First Name:
ALYSON
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700849940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 FRANCIS ST, 5TH FL, CARDIOLOGY
Provider Second Line Business Mailing Address:
BRIGHAM & WOMEN'S HOSPITAL - SHAPIRO BLDG
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:
857-307-1945
Provider Business Mailing Address Fax Number:
857-307-2022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 COLLIER RD NW
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-355-9815
Provider Business Practice Location Address Fax Number:
404-350-0529
Provider Enumeration Date:
04/10/2006

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: 363A00000X , with the licence number:  004778 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 356064994B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 356064994A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101152700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com