1720054893 NPI number — DR. VIRGINIA L. WALTERS MD

Table of content: DR. VIRGINIA L. WALTERS MD (NPI 1720054893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720054893 NPI number — DR. VIRGINIA L. WALTERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTERS
Provider First Name:
VIRGINIA
Provider Middle Name:
L.
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:
1720054893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 MOODY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUDLOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01056-1246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-390-1815
Provider Business Mailing Address Fax Number:
770-666-9450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-582-2175
Provider Business Practice Location Address Fax Number:
413-582-2954
Provider Enumeration Date:
02/27/2006

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: 207ZP0102X , with the licence number:  55152 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8095528 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 114330 . This is a "BOSTON MEDICAL CENTER HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1720054893 . This is a "BLUE CROSS BLUE SHIELD OF MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1720054893 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA204044 . This is a "HARVARD PILGRIM HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110043667A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155152 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 51122 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 762995 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1720054893 . This is a "FALLON COMMUNITY HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4260599 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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