Individual
CHARLES CHRISTOPHER WALCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
40 ARCH ST, JOHNSON CITY, NY 13790-2102
(607) 763-6075
(607) 763-5234
Mailing address
346 GRAND AVE, JOHNSON CITY, NY 13790-2580
(607) 763-6075
(607) 763-5234
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
054219
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/01/2012
Last updated
08/21/2015
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