DR. ALAN ROBIN G. WALLACE (NPI# 1497752265) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497752265 |
| Entity Type | Individual |
| Full Name | DR. ALAN ROBIN G. WALLACE |
| Credential | M.D. |
| Practice Address |
372 Purgatory Rd Middletown RI 02842-5963 |
| Mailing Address |
13 Greenough Pl Newport RI 02840-2712 |
| Practice Telephone | 4018426676 |
| Practice Fax Number | 8018426681 |
| Mailing Telephone | 4018471615 |
| Mailing Fax Number | 4018471615 |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
MD03883 | RI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | RI-BC&BS | 27129-3 | 01 |
| RI | RI BLUECHIP | 002359 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902271869 | Alan William Wallace | Specialist/Technologist | 2281 Antigua Dr, Apt. 1c, Columbus, OH 43235-6122 | 2015-12-03 |
| 1689740631 | Alan Craig Wallace | Dentist | 1497 N Highway 5, Camdenton, MO 65020 | 2006-11-28 |
| Street Address |
372 PURGATORY RD |
| City | MIDDLETOWN |
| State | RI |
| Zip Code | 02842-5963 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427671478 | Shannon M. Pine | Counselor | E Admiralty Drive, 2, Middletown, RI 02842 | 2020-05-26 |
| 1912425968 | Gail Demarco | Registered Nurse | 127 Johnnycake Hill Road, Middletown, RI 02842 | 2017-08-30 |
| 1790201861 | Logan Christopher Menard | Specialist/Technologist | 4 Orville Drive, Middletown, RI 02842 | 2017-08-20 |
| 1295149714 | Jacquelyn Marez | Occupational Therapy Assistant | 1998 West Main Rd, Middletown, RI 02842 | 2014-06-12 |
| 1144660465 | Brittney Lea Barry | Audiologist | Naval Health Clinic New England 43 Smith Rd., Newport, RI 02842 | 2013-07-01 |
| 1912262445 | Wendy S Drysdale | Student in an Organized Health Care Education/Training Program | 372 Purgatory Road, St. George's School, Middletown, RI 02842 | 2012-07-11 |
| 1912294778 | Laurie B Phenix | Pharmacist | 88 Silva Lane, Tech 4, Suite 110, Middletown, RI 02842 | 2011-06-30 |
| 1023278249 | Ann Marie Efflandt | Speech-Language Pathologist | 333 Green Ave, Middletown, RI 02842 | 2008-06-11 |
| 1669631487 | Tiffany Bourquin | Counselor | 575 E Main Rd Unit 4, Middletown, RI 02842 | 2008-06-06 |
| 1104048396 | Valley Primary Care Inc | Family Medicine | 294 Valley Road, Middletown, RI 02842 | 2007-05-03 |
| Find all providers in zip 02842 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| 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/certification - 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 |
|---|---|---|---|---|
| 1982706032 | John Gerald Pitegoff | Pediatrics | 1225 Silver St, Middletown, CT 06457-3920 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639499395 | Jack Rusley | Pediatrics | 1 Hoppin St Ste 305, Providence, RI 02903-4141 | 2010-06-04 |
| 1285857219 | E.p. Mennillo, M.d., Inc | Pediatrics | 994 Reservoir Ave, Cranston, RI 02910-5122 | 2007-04-10 |
| 1790830339 | Santiago Medical Group, Inc. | Pediatrics | 967 Mineral Spring Avenue, North Providence, RI 02904-4934 | 2007-01-24 |
| 1780737296 | We Luv Kids Inc | Pediatrics | 85 Beach St # B, Westerly, RI 02891-2717 | 2007-01-19 |
| 1215015136 | Northern Rhode Island Pediatrics | Pediatrics | 2140 Mendon Rd Ste 201, Cumberland, RI 02864-3833 | 2006-11-01 |
| 1912098336 | Miguel A Fuentes | Pediatrics | 967 Mineral Spring Ave, North Providence, RI 02904-4934 | 2006-09-28 |
| 1639260656 | Robert Arthur Brogan | Pediatrics | 27 Division St, East Greenwich, RI 02818-3872 | 2006-09-27 |
| 1700841616 | Lauren C Noel | Pediatrics | 46 Holley St, Wakefield, RI 02879-3325 | 2006-04-20 |
| 1093776296 | Russell Drew Stokes | Pediatrics | 85 Beach St, Suite B, Westerly, RI 02891-2717 | 2006-03-29 |
| 1891792065 | Dante A. Ramos | Pediatrics | 126 Prospect St, Pawtucket, RI 02860-4429 | 2005-07-03 |
| Find all providers with the same taxonomy | ||||
| City | MIDDLETOWN |
| Zip Code | 02842 |
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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.