Individual
CLOVA WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
865 E 4TH ST, BETHLEHEM, PA 18015-1935
(610) 691-4357
(484) 221-9130
Mailing address
PO BOX 4240, ALLENTOWN, PA 18105-4240
(484) 432-6848
(888) 416-1801
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD040380-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001175208
—
PA
01
—
596189
GATEWAY 65 COMPLETE
PA
01
—
E45224
AMERIHEALTH 65 COMPLETE
PA
Enumeration date
02/08/2007
Last updated
12/14/2020
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