1982856928 NPI number — DR. RICHARD LAWRENCE WALTERS DO

Table of content: (NPI 1689658023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982856928 NPI number — DR. RICHARD LAWRENCE WALTERS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTERS
Provider First Name:
RICHARD
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1982856928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
188 FRIES MILL RD
Provider Second Line Business Mailing Address:
SUITE N-1
Provider Business Mailing Address City Name:
TURNERSVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08012-2015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-783-2241
Provider Business Mailing Address Fax Number:
856-783-2243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
188 FRIES MILL RD
Provider Second Line Business Practice Location Address:
SUITE N-1
Provider Business Practice Location Address City Name:
TURNERSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-783-2241
Provider Business Practice Location Address Fax Number:
856-783-2243
Provider Enumeration Date:
10/22/2008

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: 207R00000X , with the licence number:  OT011876 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 25MB08952800 , 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)

  • Identifier: 0295035 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01085885 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".