Individual
BRIAN WALSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4702 N 5TH ST, PHILADELPHIA, PA 19120-4108
(215) 329-4888
(215) 329-5615
Mailing address
4702 N 5TH ST, PHILADELPHIA, PA 19120-4108
(215) 329-4888
(215) 329-5615
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS006489L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0091396000
IBC
PA
01
—
192650
MEDICARE
PA
Enumeration date
06/06/2006
Last updated
02/07/2008
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