MICHAEL ANTHONY WALLACE (NPI# 1427216837) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427216837 |
| Entity Type | Individual |
| Full Name | MICHAEL ANTHONY WALLACE |
| Credential | IDC |
| Practice Address |
620 John Paul Jones Cir Portsmouth VA 23708-2111 |
| Practice Telephone | 7579536505 |
| Mailing Telephone | 7579536505 |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2011-06-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417014424 | Michael J Wallace | Dentist | 1600 E 19th St, Suite 301, Edmond, OK 73013-6622 | 2007-01-02 |
| 1518042696 | Michael J. Wallace | Dentist | 1263 High St, Auburn, CA 95603-5016 | 2006-10-26 |
| 1124127279 | Michael James Wallace | Dentist | 1195 W Mason St, Green Bay, WI 54303-2045 | 2006-09-22 |
| 1679585038 | Michael Patrick Wallace | Dentist | 9225 Manchester Rd, Suite 101, Saint Louis, MO 63144-2640 | 2006-08-13 |
| 1467438937 | Michael Lloyd Wallace | Pathology | 522 Alpha Dr, Pittsburgh, PA 15238-2912 | 2005-12-16 |
| 1609356864 | Michael Wallace | Physical Therapy Assistant | 5455 Knickerbocker Rd, San Angelo, TX 76904-7711 | 2018-08-17 |
| 1225579899 | Michael Wallace | Counselor | 500 Allerton St, Second Floor, Redwood City, CA 94063-1519 | 2017-03-16 |
| 1376922948 | Michael Taylor Wallace | Ophthalmology | 930 Madison Ave Ste 200, Memphis, TN 38103 | 2015-05-28 |
| 1194029777 | Michael T Wallace | Nurse Practitioner | 9900 Bren Rd E, Minnetonka, MN 55343-9664 | 2010-12-22 |
| 1003116658 | Michael Eugene Wallace | Psychologist | 201 E Liberty St, Suite 2, Ann Arbor, MI 48104-2118 | 2010-10-29 |
| Street Address |
620 JOHN PAUL JONES CIR |
| City | PORTSMOUTH |
| State | VA |
| Zip Code | 23708-2111 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427054840 | Debra Tooke Crowell | Registered Nurse | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2005-06-21 |
| 1659970424 | Jennifer T Birchwale | Student in an Organized Health Care Education/Training Program | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-10-22 |
| 1861091985 | Carin Kimberly Teeters | Psychologist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-10-20 |
| 1275130825 | Dartangion Pierre Walker | Dental Hygienist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-10-07 |
| 1750996054 | Kevin Wilfong | Psychologist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-09-14 |
| 1598379901 | Paula Shepard | Psychologist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-09-02 |
| 1578177234 | Rebekah Gunter | Psychologist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-09-01 |
| 1225641863 | Dylan Quoc-chuong Vu | Dentist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-08-24 |
| 1467060111 | Ili Yuan | Dentist | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-07-20 |
| 1750909172 | Marsades Ceasar | Social Worker | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2020-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932724754 | William Dowling | Student in an Organized Health Care Education/Training Program | 260 John Paul Jones Circle, Fpo, AA 23708 | 2020-06-09 |
| 1760003156 | Kylie Miller | Student in an Organized Health Care Education/Training Program | 600 John Paul Jones Circle, Portsmouth, VA 23708 | 2020-04-27 |
| 1750900304 | Jonathan David Hickman | Student in an Organized Health Care Education/Training Program | Nmcp 620 John Paul Jones Cir., Bldg 3, Portsmouth, VA 23708 | 2020-04-14 |
| 1447716550 | Nathan Le Holterman | Student in an Organized Health Care Education/Training Program | Navy Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708 | 2019-02-13 |
| 1467930545 | Jonathan Volland | Dentist | Naval Medical Center - 620 John Paul Jones Cr, Portsmouth, VA 23708 | 2018-08-01 |
| 1629570171 | Brendan James O'shea | Student in an Organized Health Care Education/Training Program | 690 John Paul Jones Circle, Fpo, AA 23708 | 2018-03-01 |
| 1467909077 | Patricia Hicks Smith | Nurse Practitioner | 620 John Paul Jones Blvd., Naval Medical Center Portsmouth, Portsmouth, VA 23708 | 2016-09-01 |
| 1790139392 | Lauren Pitters | Student in an Organized Health Care Education/Training Program | 620 John Paul Jones Circle Drive, Naval Medical Center Portsmouth, Portsmouth, VA 23708 | 2016-04-20 |
| 1841683745 | Karrie Anne Brondell Walker | Student in an Organized Health Care Education/Training Program | 620 John Paul Jones, Naval Medical Center Portsmouth, Portsmouth, VA 23708 | 2015-03-17 |
| 1962821967 | Jody Manners | Psychiatry & Neurology | 620 John Paul Jones Cir # 2e, Portsmouth, VA 23708 | 2014-04-08 |
| Find all providers in zip 23708 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073941811 | Aaron Pines | Military Health Care Provider | 264 Tigerlilly Dr, Portsmouth, VA 23701-2727 | 2013-10-14 |
| 1558658757 | Gary James Sweet | Military Health Care Provider | 1 Ayres Circle, Bldg. H-1, Pnsy, Naval Branch Health Clinic, Portsmouth, NH 03804 | 2011-07-08 |
| 1093019853 | Jeffrey Wilcox | Military Health Care Provider | Bldg 1575 Norfolk Naval Shipyard, Maritime Expeditionary Support Group Two, Portsmouth, VA 23709 | 2011-01-07 |
| 1558592675 | Kevin Leigh Russell | Military Health Care Provider | Msron-6, Bldg 15, Norfolk Naval Shipyard, Portsmouth, VA 23709 | 2009-08-06 |
| 1144479213 | Jay Hays Mcdowell Sr. | Military Health Care Provider | Bhc Nnsy, Bldg 277, Portsmouth, VA 23709-1001 | 2008-09-15 |
| 1356533731 | Teresa A Kirkland | Military Health Care Provider | Code 100 M, Building 277, Portsmouth, VA 23709-5000 | 2007-08-09 |
| 1326242215 | Thomas Michael Kaptur | Military Health Care Provider | Naval Costal Warfare Squadron Four, Norfolk Naval Shipyard Bldg 11, Portsmouth, VA 23701 | 2007-06-13 |
| 1861600389 | Christopher Robin Maurer | Military Health Care Provider | Ncws 4, Ibu 41, Nnsy Bldg 11, Portsmouth, VA 23709 | 2007-05-18 |
| 1588879779 | Ralph Allen Rowe Jr. | Military Health Care Provider | Mobile Security Squadron Six, Nnsy Bld 15, Portsmouth, VA 23709-5000 | 2007-05-11 |
| 1609080589 | Luis Alexander Glinton | Military Health Care Provider | Norfolk Naval Shipyard, Bldg 15, Portsmouth, VA 23709 | 2007-05-09 |
| Find all providers in PORTSMOUTH | ||||
| City | PORTSMOUTH |
| Zip Code | 23708 |
Please comment or provide details below to improve the information on MICHAEL ANTHONY WALLACE.
| 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.