Basic Information
| Provider Information | |||||||||
| NPI: | 1194766220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | RAJANI | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 UNIVERSITY DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157107037 | ||||||||
| FaxNumber: | 2157105181 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 TOWNSEND AVE | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563223260 | ||||||||
| FaxNumber: | 8563223061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MA39648 | NJ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | MD028249E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD028249E | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 0014803490004 | 05 | PA | MEDICAID | 1194766220 | 01 | PA | KEYSTONE IBC | OTHER | 1367087 | 01 | PA | CIGNA PA | OTHER | 1926403 | 05 | NJ | MEDICAID | 2663312 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 4203863 | 01 | PA | AETNA | OTHER |