Basic Information
| Provider Information | |||||||||
| NPI: | 1255325775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 STATE ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777157 | ||||||||
| FaxNumber: | 8148772844 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PEACH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148775700 | ||||||||
| FaxNumber: | 8148775655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 01/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35088817 | OH | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD039336L | PA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 000000537030 | 01 | OH | ANTHEM | OTHER | 2697809 | 05 | OH | MEDICAID | 0982776 | 05 | PA | MEDICAID | 7263676 | 01 | AETNA | OTHER |