ELIZABETH MARY WALLIS (NPI# 1023344025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023344025 |
| Entity Type | Individual |
| Full Name | ELIZABETH MARY WALLIS |
| Credential | M.D. |
| Practice Address |
171 Ashley Ave Charleston SC 29425-8908 |
| Mailing Address |
Po Box 751461 Charlotte NC 28275-1461 |
| Practice Telephone | 8437921414 |
| Mailing Telephone | 8437926200 |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2020-10-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 35842 | SC | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | MD439393 | PA | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | MT190583 | PA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326681800 | Elizabeth Wallis | Physician Assistant | 7400 France Ave S Ste 100, Edina, MN 55435-4738 | 2019-10-28 |
| 1821551334 | Elizabeth Nicole Wallis | Student in an Organized Health Care Education/Training Program | 7777 Hennessy Blvd Ste 6004, Baton Rouge, LA 70808-4300 | 2019-04-11 |
| 1740528546 | Elizabeth Leanne Wallis | Nurse Practitioner | 110 Medical Cir, Nashville, AR 71852-8606 | 2013-01-29 |
| Street Address |
171 ASHLEY AVE |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29425-8908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942203922 | Nicholas J Pastis Jr. | Internal Medicine | 171 Ashley Ave, Charleston, SC 29425-8900 | 2005-05-24 |
| 1760083745 | Eleta Lazar Donelan | Physician Assistant | 171 Ashley Ave, Charleston, SC 29425-0100 | 2020-11-05 |
| 1285231340 | Bree Romecki | Nurse Practitioner | 171 Ashley Ave, Charleston, SC 29425-0100 | 2020-10-02 |
| 1942812078 | Warren Allen James | Student in an Organized Health Care Education/Training Program | 171 Ashley Ave, Charleston, SC 29425-8908 | 2020-08-19 |
| 1457962060 | Rosmary Ros-demarize | Psychologist | 171 Ashley Ave, Charleston, SC 29425-0100 | 2020-08-17 |
| 1558971390 | Auryelle Ascue | Nurse Practitioner | 171 Ashley Ave, Charleston, SC 29425-8908 | 2020-08-06 |
| 1396361994 | David Gonzalez | Nurse Practitioner | 171 Ashley Ave, Charleston, SC 29425-8911 | 2020-06-19 |
| 1003432592 | Hannah Burrick | Audiologist | 171 Ashley Ave, Charleston, SC 29425-8903 | 2020-06-19 |
| 1528683562 | Kelsey Renee Full | Emergency Medicine | 171 Ashley Ave, Charleston, SC 29425-0100 | 2020-06-16 |
| 1861017949 | Christina Lee | Anesthesiology | 171 Ashley Ave, Charleston, SC 29425-8908 | 2020-06-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922607217 | Krishna Bhandari | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 10 Mcclennan Banks Drive, 2190-r, Msc 918, Charleston, SC 29425 | 2020-10-19 |
| 1649892456 | Mary Macrae Lynch | Social Worker | 179 Ashley Avenue, Charleston, SC 29425 | 2020-05-14 |
| 1528600053 | Amanda Watts | Physician Assistant | 135 Rutledge Ave. Msc 561, Charleston, SC 29425 | 2019-10-16 |
| 1851945497 | Kacy Wonder | Dentist | 173 Ashley Avenue Room 453 Msc 507, Charleston, SC 29425 | 2019-08-01 |
| 1477114569 | Justin Robert Silverman | Surgery | 169 Ashley Avenue, Room 202 Muh, Msc 333, Charleston, SC 29425 | 2019-06-28 |
| 1740840024 | Tyler Buckley | Surgery | 169 Ashley Ave, Room 202 Main Hospital, Msc333, Charleston, SC 29425 | 2019-06-18 |
| 1366001760 | Rayphael Sebastian Hardy | Internal Medicine | 169 Ashley Avenue Room 202 Main Hospital Msc333, Charleston, SC 29425 | 2019-06-10 |
| 1437718889 | Samar Medani | Internal Medicine | Division of Nephrology, Medical Univ of South Carolina, 96 Jonathan Lucas Street, Room 822, Msc 629, Charleston, SC 29425 | 2019-06-10 |
| 1427617950 | Emily Suzanne Nyers | Internal Medicine | 169 Ashley Ave., Room 202 Main Hospital, Msc 333, Charleston, SC 29425 | 2019-06-09 |
| 1790343564 | Alan Cowei Peh | Psychiatry & Neurology | 169 Ashley Avenue Rm 202, Main Hospital Msc 333, Charleston, SC 29425 | 2019-06-05 |
| Find all providers in zip 29425 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023632809 | Caitlin Marie Stoll | Pediatrics | 2244 Ashley Crossing Dr Unit 536, Charleston, SC 29414-6168 | 2020-06-08 |
| 1134743420 | Elizabeth Alden Mccants | Pediatrics | 125 Doughty St Ste 520d, Charleston, SC 29403-5736 | 2020-06-02 |
| 1770127516 | Nicole Danielle Clendenin | Pediatrics | 314 Goff Mountain Rd Ste 16, Charleston, WV 25313-6600 | 2019-11-05 |
| 1871059238 | Aminah Fraser- Abdur Rahim | Pediatrics | 1373 W Lenevar Dr, Charleston, SC 29407-5148 | 2019-02-11 |
| 1720518384 | Nicholas Matthew Cundiff | Pediatrics | 135 Rutledge Ave Dept Of, Charleston, SC 29425-8903 | 2017-06-15 |
| 1649632225 | Collin Dubick | Pediatrics | 1118 Sea Eagle Watch, Charleston, SC 29412-8249 | 2016-03-23 |
| 1417338781 | Heather Michelle Greene | Pediatrics | 169 Ashlet Avenue, Room 202 Main Hospital Msc 333, Charleston, SC 29425 | 2015-06-12 |
| 1780098160 | Matthew John Saia | Pediatrics | 2124 Telfair Way, Charleston, SC 29412-2370 | 2014-06-13 |
| 1770922601 | Lauren Simpson Tipton | Pediatrics | 1243 Savannah Hwy Ste B, Charleston, SC 29407-7817 | 2013-06-25 |
| 1467747527 | Pratikkumar Patel | Pediatrics | 830 Pennsylvania Ave Ste 401, Charleston, WV 25302-3390 | 2011-06-16 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 29425 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.