Individual
CORNELIUS TODD WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
133 N HOWARD AVE, LANDRUM, SC 29356
(864) 560-9507
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17420
SC
207Q00000X
Family Medicine Physician
9601513
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080120336
RAIL ROAD MEDICARE
SC
05
—
174206
—
SC
01
—
2279674C
MEDICARE PIN
NC
01
—
5850260
AETNA
SC
01
—
66392
MEDCOST
SC
05
—
890665G
—
NC
01
—
F876975121
MEDICARE PIN
SC
01
—
P00721817
RR MEDICARE
NC
Enumeration date
01/31/2006
Last updated
01/13/2021
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