Active NPI
Mary P Walsh, DO
- Pediatrics Physician
- East Waterboro, ME
National Provider Identifier
1699747246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 1532
- Practice address
- 43 Sokokis Trail
East Waterboro, ME 04030 - Phone
- (207) 247-6742
- Fax
- (207) 247-6114
- NPI assigned
- Feb 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 1532 | ME | Primary |
Addresses
Primary practice location
43 Sokokis Trail
East Waterboro, ME 04030
Mailing address
PO Box 1849
Lewiston, ME 04241-1849
Phone (207) 784-2554
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 270380099 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1532 | ME | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317600000000",
"number": "1699747246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1849",
"city": "LEWISTON",
"state": "ME",
"postal_code": "042411849",
"telephone_number": "207-784-2554",
"fax_number": "207-777-5363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43 SOKOKIS TRAIL",
"city": "EAST WATERBORO",
"state": "ME",
"postal_code": "04030",
"telephone_number": "207-247-6742",
"fax_number": "207-247-6114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALSH",
"first_name": "MARY",
"middle_name": "P",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-07",
"last_updated": "2011-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ME",
"license": "1532",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "270380099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Waterboro, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.