Provider Demographics
NPI:1538196662
Name:WALKER, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:WALKER
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5131
Mailing Address - Fax:740-446-5486
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5131
Practice Address - Fax:740-446-5486
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-7305207R00000X, 207RX0202X
WV15377207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH900000134OtherRR MEDICARE
OH000000181881OtherUNISON MEDICAID #
WV0083691000Medicaid
000000006739OtherANTHEM BCBS
OH0488628OtherMOLINA MEDICAID #
001714036OtherMOUNTAIN STATE BCBS
OH0488628Medicaid
OH310917085096OtherCARESOURCE MEDICAID #
OH900000134OtherRR MEDICARE
OH0488628OtherMOLINA MEDICAID #
OH0488628Medicaid