PAUL WALLACE (NPI# 1639287212) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639287212 |
| Entity Type | Individual |
| Full Name | PAUL WALLACE |
| Credential | M.D. |
| Practice Address |
3400 Spruce St 5 Maloney Philadelphia PA 19104-4238 |
| Practice Telephone | 2156627355 |
| Mailing Telephone | 2156627355 |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2016-08-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD458894 | PA | Allopathic & Osteopathic Physicians |
| N | 208M00000X | Hospitalist | A68890 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A688900 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629054598 | Paul Wayne Wallace | Pharmacist | 315 Mlk Way, Tacoma, WA 98405 | 2005-12-21 |
| 1265991335 | Paul Michael Wallace | Psychiatry & Neurology | 401 Parnassus Ave, San Francisco, CA 94143-0984 | 2019-03-18 |
| 1669794764 | Paul John Wallace | Pharmacist | 1993 Dickerson Blvd, Monroe, NC 28110-2795 | 2010-02-17 |
| 1548444318 | Paul S Wallace | Licensed Practical Nurse | 513 Se Quapaw, Bartlesville, OK 74003 | 2007-12-28 |
| 1114044799 | Paul David Wallace | Licensed Psychiatric Technician | 1212 N California St, Stockton, CA 95202-1552 | 2007-03-26 |
| 1770649741 | Paul D Wallace | Dentist | 8305 Walnut Hill Ln, Suite 235, Dallas, TX 75231-4217 | 2006-12-27 |
| 1306875869 | Paul R. Wallace | Family Medicine | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2006-06-30 |
| 1063494474 | Paul Wesley Wallace | Dermatology | 8920 Wilshire Blvd, Suite 327, Beverly Hills, CA 90211-2007 | 2005-11-19 |
| Street Address |
3400 SPRUCE ST 5 MALONEY |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19104-4238 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063415966 | Samuel Isaiah Parry | Obstetrics & Gynecology | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2005-05-24 |
| 1831790609 | Renate Marie Balitzky | Registered Nurse | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-11-06 |
| 1053911156 | Jordan Charles Templeton | Physician Assistant | 3400 Spruce St, Philadelphia, PA 19104-4274 | 2020-10-28 |
| 1992305304 | Alyssa N Volpe | Registered Nurse | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-10-27 |
| 1700486115 | Christina Haddow | Registered Nurse | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-10-27 |
| 1629677497 | Marissa Leigh Berlant | Physician Assistant | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-10-22 |
| 1811595523 | Kristen Gilgen | Anesthesiology | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-10-14 |
| 1962014654 | Stacey Pham | Nurse Practitioner | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-08-23 |
| 1265040109 | Abdullah T Almuqate | Pathology | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-07-16 |
| 1952928541 | Stefen Andrianus | Student in an Organized Health Care Education/Training Program | 3400 Spruce St, Philadelphia, PA 19104-4238 | 2020-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770829 | Michelle Morris | Student in an Organized Health Care Education/Training Program | Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 | 2020-11-04 |
| 1346853041 | Spectrum Health Services, Inc. | Clinic/Center | 1415 South University Ave, Philadelphia, PA 19104 | 2020-08-24 |
| 1770104259 | Fatimah Sorefan-mangou | Student in an Organized Health Care Education/Training Program | 4 Maloney 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1114548690 | Rebecca Blaguski | Registered Nurse | The Hospital of The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1952944175 | Rebecca Miriam Barmherzig | Psychiatry & Neurology | 3501 Civic Centre Blvd, 10th Flr Ctrb, Neurology, Philadelphia, PA 19104 | 2019-10-21 |
| 1891257101 | James Paul Byrne | Surgery | Penn Presbyterian Medical Center, Division of Trauma, S, 51 N. 39th Street, Suite 120, 1st Floor Medical Office, Philadelphia, PA 19104 | 2019-04-04 |
| 1093276453 | Lauren Shreve | Student in an Organized Health Care Education/Training Program | Department of Surgery, Surgery Education - Penn Health, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104 | 2019-03-28 |
| 1285194282 | Lauren M Christie | Student in an Organized Health Care Education/Training Program | Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104 | 2019-03-25 |
| 1114487683 | Sabrina Layne | Student in an Organized Health Care Education/Training Program | 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 | 2019-03-21 |
| 1811457310 | Kia Lor | Student in an Organized Health Care Education/Training Program | Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 | 2019-03-21 |
| Find all providers in zip 19104 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427674407 | Jun Song | Internal Medicine | 3401 N Broad St Ste 801, Philadelphia, PA 19140-5103 | 2020-06-24 |
| 1932725264 | Aaron Leo Yazdian | Internal Medicine | 1335 South St Apt A, Philadelphia, PA 19147-1841 | 2020-06-23 |
| 1144846387 | Rishabh Khatri | Internal Medicine | 322 N Broad St Apt 1523, Philadelphia, PA 19102-1122 | 2020-06-23 |
| 1215564521 | Insight Home Physicians, PC | Internal Medicine | 7806 Cresheim Rd, Philadelphia, PA 19118-4003 | 2020-03-25 |
| 1457995938 | Tower Drexel Academic Medical Group LLC | Internal Medicine | 3401 Market St Ste 105b, Philadelphia, PA 19104-3315 | 2019-10-29 |
| 1205479904 | Tower Drexel Academic Medical Group LLC | Internal Medicine | 219 N Broad St 8fl, Philadelphia, PA 19107-1507 | 2019-10-25 |
| 1700439056 | Alvaro Goncalves Mendes Neto | Internal Medicine | 5501 Old York Rd # 363, Philadelphia, PA 19141-3018 | 2019-07-16 |
| 1720648223 | Ali Haydar | Internal Medicine | 245 N. 15th St, 6th Floor, Ms 42, Philadelphia, PA 19102 | 2019-06-17 |
| 1114587672 | Stephen Michael Pokrywa | Internal Medicine | Drexel University Com, Internal Medicine Residency, 245 N. 15th St., 6th Floor, Ms 427, Philadelphia, PA 19102-1178 | 2019-06-17 |
| 1124688734 | Aakash Patel | Internal Medicine | Drexel University College of Medicine-internal Medicine, 245 N. 15th St. 6th Floor, Ms 427, Philadelphia, PA 19102 | 2019-06-17 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19104 |
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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.