Individual
LYLE G WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8992 UNIVERSITY BLVD STE 300, NORTH CHARLESTON, SC 29406-8104
(843) 876-8279
Mailing address
PO BOX 602108, CHARLOTTE, NC 28260-2108
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20374
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110206688
RAILROAD MEDICARE ID#
SC
05
—
203746
—
SC
Enumeration date
04/05/2006
Last updated
07/05/2012
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