Provider Demographics
NPI:1679566384
Name:WALSHIN, DAVID BRUCE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:WALSHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 BEDFORD ST APT 4H
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5216
Mailing Address - Country:US
Mailing Address - Phone:203-352-1217
Mailing Address - Fax:203-902-0152
Practice Address - Street 1:1425 BEDFORD ST APT 4H
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5216
Practice Address - Country:US
Practice Address - Phone:203-352-1217
Practice Address - Fax:203-902-0152
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2024-07-05
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CT034578208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001345786Medicaid
CT250000174Medicare PIN