MR. KEVIN WALLACE (NPI# 1225388457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225388457 |
| Entity Type | Individual |
| Full Name | MR. KEVIN WALLACE |
| Practice Address |
30 Warren St Boston MA 02135-3602 |
| Mailing Address |
555 Washington St Brighton MA 02135-2591 |
| Practice Telephone | 6172543800 |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2012-09-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | S50607188 | MA | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659760700 | Kevin Wallace | Naturopath | 1700 N Tully Rd Apt G221, Turlock, CA 95380-6879 | 2015-01-13 |
| 1144576919 | Kevin Gary Wallace | Pharmacist | 94 Ladd Ave, Staten Island, NY 10312-1515 | 2012-07-31 |
| 1972750909 | Kevin D Wallace | Dentist | 1200 E Woodhurst Dr Ste A200, Springfield, MO 65804-3745 | 2008-08-21 |
| 1316960131 | Kevin Bruce Wallace | Dentist | 949 N 14th St, Leesburg, FL 34748-3838 | 2006-07-25 |
| 1033619614 | Kevin R Wallace | Case Manager/Care Coordinator | 3620 Stutz Dr, Canfield, OH 44406-9176 | 2018-02-20 |
| 1518391135 | Kevin Wallace | Massage Therapist | 817 Coffee Rd Ste D, Modesto, CA 95355-4241 | 2013-08-30 |
| 1053423285 | Kevin R Wallace | Dentist | 150 E Huron St, Ste 1103, Chicago, IL 60611 | 2006-09-01 |
| 1730128372 | Kevin L Wallace | Preventive Medicine | 925 E Mcdowell Rd, Phoenix, AZ 85006-2502 | 2006-06-06 |
| 1255309258 | Kevin Ps Wallace | Internal Medicine | 1300 Crane St, Menlo Park, CA 94025-4260 | 2006-03-08 |
| 1033195631 | Kevin H Wallace | Internal Medicine | 1350 Hickory St, Melbourne, FL 32901-3224 | 2005-12-16 |
| Street Address |
30 WARREN ST |
| City | BOSTON |
| State | MA |
| Zip Code | 02135-3602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639721798 | Nancy Tran | Occupational Therapist | 30 Warren St, Boston, MA 02135-3602 | 2019-07-09 |
| 1952878399 | Anne Hannan | Social Worker | 30 Warren St, Boston, MA 02135-3602 | 2018-10-24 |
| 1265911390 | Lauren Sterlin | Physical Therapist | 30 Warren St, Boston, MA 02135-3602 | 2018-08-09 |
| 1104345073 | Kathleen S Holte | Student in an Organized Health Care Education/Training Program | 30 Warren St, Boston, MA 02135-3602 | 2017-09-12 |
| 1972022077 | Megan Ahnen | Student in an Organized Health Care Education/Training Program | 30 Warren St, Boston, MA 02135-3602 | 2017-09-11 |
| 1801314463 | Katherine Jordan | Counselor | 30 Warren St, Boston, MA 02135 | 2017-09-05 |
| 1134646334 | Sarah Williams | Occupational Therapist | 30 Warren St, Boston, MA 02135-3602 | 2017-08-28 |
| 1467909671 | Jordan Constance | Psychologist | 30 Warren St, Boston, MA 02135-3602 | 2016-09-06 |
| 1972972081 | Olivia Tosi | Student in an Organized Health Care Education/Training Program | 30 Warren St, Boston, MA 02135-3602 | 2015-09-18 |
| 1033585898 | Marcela Teresa Donat | Physical Therapist | 30 Warren St, Boston, MA 02135-3602 | 2015-08-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699392944 | Nur Zeynep Ay | Student in an Organized Health Care Education/Training Program | 736 Cambridge Street St Elizabeths Medical Center, Graduate Medical Education (diane Giacalone), Boston, MA 02135 | 2020-07-02 |
| 1104470673 | Domenique Delucia | Counselor | 77f Warren Street, Brighton, MA 02135 | 2019-08-01 |
| 1831751684 | Meredith Mcghee | Audiologist | 736 Cambridge Street Smc-8, Brighton, MA 02135 | 2019-07-02 |
| 1730645847 | Delphine Alignol | Family Medicine | 330 Mount St, Cambridge, MA 02135 | 2019-02-13 |
| 1124501960 | Ellen Elizabeth Miller | Social Worker | 44 Mt Vernon St, Brighton, MA 02135 | 2018-09-07 |
| 1710466180 | Sharon Pae | Acupuncturist | 135 Chiswick Rd Bsmt, Brighton, MA 02135 | 2018-08-07 |
| 1750877155 | Leonid Sigal | Counselor | 9 South St Apt 2, Brighton, MA 02135 | 2018-07-09 |
| 1689165425 | Brian George Mcguire | Dentist | 24 Sidlaw Rd, Brighton, MA 02135 | 2018-05-29 |
| 1619467214 | Ashley Marie Arbuckle | Counselor | 77 Waren Street, Building 9, Brighton, MA 02135 | 2018-05-18 |
| 1871098962 | Arina Sorokina | Dentist | Charles River Community Health Center, 495 Western Avenue, Allston, MA 02135 | 2018-03-29 |
| Find all providers in zip 02135 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447636 | Sarah Wieman | Student in an Organized Health Care Education/Training Program | 16 Blossom St Fl 1, Boston, MA 02114-3104 | 2020-11-03 |
| 1932709938 | Brianna Mae Duval | Student in an Organized Health Care Education/Training Program | 58 Colborne Rd, Boston, MA 02135-4103 | 2020-10-28 |
| 1780281279 | Sarah Hamad Alsaggabi | Student in an Organized Health Care Education/Training Program | 55 Traveler St Apt 1310, Boston, MA 02118-2973 | 2020-10-07 |
| 1821695933 | Matthew John Needham | Student in an Organized Health Care Education/Training Program | 330 Brookline Ave, Yamins 2nd Floor, Department of Anesthesia, Boston, MA 02215 | 2020-10-02 |
| 1013524339 | Jacqueline Busa | Student in an Organized Health Care Education/Training Program | Northeastern University 336 Huntington Ave, Boston, MA 02115 | 2020-09-30 |
| 1558978957 | Tien-hsin Chang | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street (tufts University School of Dental Me, Boston, MA 02111 | 2020-09-29 |
| 1417564279 | Katherine Rose Brainard | Student in an Organized Health Care Education/Training Program | 336 Huntington Avenue, Boston, MA 02115 | 2020-09-25 |
| 1962018069 | Cara Connors | Student in an Organized Health Care Education/Training Program | 18 Wiget St Apt 1, Boston, MA 02113-2363 | 2020-09-23 |
| 1023624608 | Bernadette Avila | Student in an Organized Health Care Education/Training Program | 19 Peterborough St Apt 5, Boston, MA 02215-4409 | 2020-09-19 |
| 1588276281 | Guoliang Qiao | Student in an Organized Health Care Education/Training Program | Massachusetts General Hospital, 55 Fruit Street., Boston, MA 02114 | 2020-08-24 |
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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.