Provider Demographics
NPI:1548290927
Name:WALPOLE, SEAN M (DPM)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:WALPOLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S OCTORARA TRL
Mailing Address - Street 2:SUITE 160/170
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-2100
Mailing Address - Country:US
Mailing Address - Phone:866-871-0851
Mailing Address - Fax:610-857-6638
Practice Address - Street 1:950 S OCTORARA TRL
Practice Address - Street 2:SUITE 160/170
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365-2100
Practice Address - Country:US
Practice Address - Phone:866-871-0851
Practice Address - Fax:610-857-6638
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004518L213E00000X
DEE10000157213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50133623OtherCBC
DE1000015486Medicaid
PA0335570001OtherDMEPOS
DE0335570001OtherDMEPOS
PA101317084Medicaid
PA001419065OtherHIGHMARK
PA101317084Medicaid
DE009898F28Medicare PIN
PA089946JZEMedicare PIN