Basic Information
| Provider Information | |||||||||
| NPI: | 1124174347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | FRANCIS | ||||||||
| MiddleName: | X | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 RIVER RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COS COB | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068072717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036619433 | ||||||||
| FaxNumber: | 2036612918 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 RIVER RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COS COB | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068072717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036619433 | ||||||||
| FaxNumber: | 2036612918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 14105 | CT | X | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 14105 | CT | X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 010014105CT02 | 01 | CT | ANTHEM BLUE CROSS | OTHER | 00516867 | 05 | NY | MEDICAID |