Provider Demographics
NPI:1871536847
Name:BENDER, WALTER DOOLEY (DO)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:DOOLEY
Last Name:BENDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:143 ENCLAVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-3207
Mailing Address - Country:US
Mailing Address - Phone:724-654-4118
Mailing Address - Fax:724-657-2669
Practice Address - Street 1:143 ENCLAVE DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3207
Practice Address - Country:US
Practice Address - Phone:724-654-4118
Practice Address - Fax:246-572-6697
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005585L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01924042Medicaid
PAA65385Medicare UPIN
PA01924042Medicaid