Peter G Walden, M.D

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

025502 Issued in CT

Practice address

366 Colt Hwy
Farmington, CT 06032-2547

Phone

(860) 409-0449

Fax

(860) 409-0551

NPI assigned

Jul 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334102400000",
    "number": "1346247624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 COLT HWY",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322547",
            "telephone_number": "860-409-0449",
            "fax_number": "860-409-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366 COLT HWY",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322547",
            "telephone_number": "860-409-0449",
            "fax_number": "860-409-0551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDEN",
        "first_name": "PETER",
        "middle_name": "G",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2012-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CT",
            "license": "025502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255025",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Keith Wagner, D.P.M.
• Julie A. Wagner, PHD
• Richard Kent Wagner, MD
• Courtney Leigh Stead Wakefield, MD
• Shira L Wald
• Joseph Walker, MD
• Linda Wall
• Christopher Alan Wallace, M.D.
• James Wallace Jr., M.D.
• Victor Wallock, D.M.D.

• Ophthalmology Physician in Farmington, CT
• Providers in Farmington, CT by specialty
• Ophthalmology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.