Provider Demographics
NPI:1174580534
Name:WALSH, ROBERT SEAMUS (PAC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SEAMUS
Last Name:WALSH
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:1608 FLAMMARION COURT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6910
Mailing Address - Country:US
Mailing Address - Phone:757-721-5456
Mailing Address - Fax:
Practice Address - Street 1:PHY AMERICA 1435 CROSSWAYS BLVD
Practice Address - Street 2:STE 305
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-424-7750
Practice Address - Fax:757-424-7754
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCCPA1027623363A00000X
VA0110001830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant