Provider Demographics
NPI:1174513675
Name:WALSH, MARK (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 MORGANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607-9455
Mailing Address - Country:US
Mailing Address - Phone:226-228-0476
Mailing Address - Fax:
Practice Address - Street 1:1623 MORGANTOWN RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-9455
Practice Address - Country:US
Practice Address - Phone:272-228-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007757L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1775120OtherBLUE CARE
PA819322OtherBLUE CARE HMO (FPH)
PA4407486OtherAETNA
PAP00292337OtherRAILROAD MEDICARE
PA95285-1067OtherGEISINGER
PA50076569OtherCAPITAL BLUE CROSS
PA001540071OtherMEDICAL ASSISTANCE
PA001540071-0005Medicaid
PA20041481OtherAMERIHEALTH
PA50076569OtherCAPITAL BLUE CROSS
PA001540071OtherMEDICAL ASSISTANCE