Provider Demographics
NPI:1053385310
Name:WALKER, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-4820
Mailing Address - Fax:860-358-8661
Practice Address - Street 1:250 FLAT ROCK PL
Practice Address - Street 2:2ND FL
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1565
Practice Address - Country:US
Practice Address - Phone:860-358-3640
Practice Address - Fax:860-358-8656
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT037987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001379876Medicaid
CT001379876Medicaid
CTH13814Medicare UPIN