Individual
PHYLLIS J WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
155 WILSON AVE, WASHINGTON, PA 15301-3336
(724) 225-7000
Mailing address
PO BOX 951847, CLEVELAND, OH 44193-0020
(866) 338-6471
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD028020Y
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000364349
BC BS
OH
05
—
0010729710015
—
PA
05
—
2585528
—
OH
01
—
P00230604
RAILROAD MEDICARE
PA
01
—
P00331221
RAILROAD MEDICARE
PA
Enumeration date
02/14/2006
Last updated
07/18/2007
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