DR. MICHAEL JASON WALLACE (NPI# 1902005747) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902005747 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL JASON WALLACE |
| Credential | M.D. |
| Practice Address |
3421 Benson Ave Suite 100 Baltimore MD 21227-1056 |
| Practice Telephone | 4106441880 |
| Practice Fax Number | 4106446048 |
| Mailing Telephone | 4106441880 |
| Mailing Fax Number | 4106446048 |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2014-01-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
D0065277 | MD | Allopathic & Osteopathic Physicians |
| 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 |
3421 BENSON AVE SUITE 100 |
| City | BALTIMORE |
| State | MD |
| Zip Code | 21227-1056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205838406 | Oren Gil Blam | Orthopaedic Surgery | 3421 Benson Ave, Ste 100, Baltimore, MD 21227-1011 | 2005-06-01 |
| 1639554835 | Smart Pain Management, LLC | Pain Medicine | 3421 Benson Ave, Suite 210, Baltimore, MD 21227-1056 | 2015-07-29 |
| 1316345895 | Farah Alvi | Physician Assistant | 3421 Benson Ave, Suite 210, Baltimore, MD 21227-1056 | 2014-12-15 |
| 1487055653 | Torie Mcintosh | Physical Therapist | 3421 Benson Ave, Suite 100, Baltimore, MD 21227-1056 | 2014-09-08 |
| 1083042667 | Craig M. Doxey | Physician Assistant | 3421 Benson Ave, Suite 201, Baltimore, MD 21227-1056 | 2013-10-17 |
| 1013280916 | Monica Renee Leid | Physician Assistant | 3421 Benson Ave, Suite 210, Baltimore, MD 21227-1056 | 2012-02-23 |
| 1932478161 | Denise E Patti | Physical Therapist | 3421 Benson Ave, Suite 100, Baltimore, MD 21227-1056 | 2011-12-16 |
| 1427327642 | Kerry Hickerson Hite | Physical Therapist | 3421 Benson Ave, Suite 100, Baltimore, MD 21227-1056 | 2011-12-16 |
| 1386931855 | Chesapeake Open Mri LLC | Radiology | 3421 Benson Ave, Suite 100, Baltimore, MD 21227-1056 | 2011-07-06 |
| 1801194105 | Amanda Aguilera | Physical Therapist | 3421 Benson Ave, Suite 100, Baltimore, MD 21227-1056 | 2011-03-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528622024 | Kim Conaway | Counselor | Regenerations Counseling Services, 1421 S. Canton Street, Baltimore, MD 21227 | 2019-04-30 |
| 1861974891 | Joan Lynn Indilisano | Occupational Therapist | 3320 Benson Avenue, Baltimore, MD 21227 | 2018-09-06 |
| 1821593161 | Institute for Dermatopathology, Inc. | Clinical Medical Laboratory | 1901 Sulphur Spring Rd Ste A, Baltimore, MD 21227 | 2018-03-28 |
| 1447779699 | Aja Williams | Registered Nurse | 3902 Annapolis Rd., Halethorpe, MD 21227 | 2017-09-19 |
| 1588190748 | Mentor-maryland | Community/Behavioral Health | 1540 Caton Center Drive, Halethorpe, MD 21227 | 2017-05-10 |
| 1083084180 | Institute for Family Centered Services | Community/Behavioral Health | 1540 Caton Centered Drive, Suite F, Baltimore, MD 21227 | 2015-10-01 |
| 1174913677 | Wye Oak Clinic, Inc. | Marriage & Family Therapist | 1937 Lansdowne Rd, Halethorpe, MD 21227 | 2015-02-04 |
| 1588938237 | Ahmein Watson | Social Worker | 1504 Joh Ave Ste 120, Baltimore, MD 21227 | 2012-02-28 |
| 1336442656 | Norah Orise Osian | Pharmacist | Rite Aid Pharmacy, 1400 Sulphur Spring Rd, Baltimore, MD 21227 | 2010-12-08 |
| 1366759623 | Een J Lee | Pharmacist | 1400 Sulphurspring Rd, Baltimore, MD 21227 | 2010-09-08 |
| Find all providers in zip 21227 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023665262 | Johns Hopkins University | Orthopaedic Surgery | 600 N Wolfe St, Baltimore, MD 21287-0005 | 2019-08-22 |
| 1811365828 | Lifebridge Community Physicians, Inc | Orthopaedic Surgery | 2401 W Belvedere Ave, Suite 102-104, Baltimore, MD 21215-5216 | 2015-09-08 |
| 1285930404 | Allison Liefeld Fillar | Orthopaedic Surgery | 3333 N Calvert St, Jpb, Suite 400, Baltimore, MD 21218-2867 | 2011-02-05 |
| 1780818674 | Jonathan David Packer | Orthopaedic Surgery | 110 S Paca St, 6th Floor, Suite 300, Baltimore, MD 21201-1642 | 2009-05-07 |
| 1306027263 | Chad C Zooker | Orthopaedic Surgery | 2700 Quarry Lake Drive, Suite 300, Baltimore, MD 21209 | 2007-11-20 |
| 1386851681 | Scott M Adams | Orthopaedic Surgery | 3421 Benson Ave, Suite 100, Baltimore, MD 21227-1056 | 2007-05-17 |
| 1033271697 | Jason Wilson Hammond | Orthopaedic Surgery | 3333 N Calvert St, Suite 400, Baltimore, MD 21218-2867 | 2006-12-13 |
| 1376532267 | Robert Riederman | Orthopaedic Surgery | 2700 Quarry Lake Dr, Suite 300, Baltimore, MD 21209-2230 | 2005-10-14 |
| 1639167554 | David P Buchalter | Orthopaedic Surgery | 2700 Quarry Lake Dr, Suite 300, Baltimore, MD 21209-2230 | 2005-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952812208 | Richard Thomas Travis | Orthopaedic Surgery | 3113 Catrina Ln, Annapolis, MD 21403-4340 | 2017-10-13 |
| 1104180249 | Heather Suzanne York | Orthopaedic Surgery | 10975 Guilford Rd, Annapolis Junction, MD 20701-1125 | 2012-07-03 |
| 1598725442 | Scott P Worrell | Orthopaedic Surgery | 11110 Medical Campus Road, Suite 205, Hagerstown, MD 21742 | 2006-03-24 |
| 1215925128 | Jon D Koman | Orthopaedic Surgery | 116 Westminster Pike, Suite 100, Reisterstown, MD 21136-1027 | 2005-10-13 |
| 1083617625 | Orthopaedic and Sports Medicine Center LLC | Orthopaedic Surgery | 108 Forbes St, Annapolis, MD 21401-1502 | 2005-05-27 |
| 1447636048 | Kessous & Kessous Md PC | Orthopaedic Surgery | 800 S Frederick Ave, Ste 100, Gaithersburg, MD 20877-4150 | 2015-08-05 |
| 1245632926 | Orthosurg Physician Assistants of Maryland LLC | Orthopaedic Surgery | 6430 Rockledge Dr, Suite 510, Bethesda, MD 20817-1805 | 2014-09-24 |
| 1437579596 | Centers for Advanced Orthopaedics, LLC | Orthopaedic Surgery | 5530 Wisconsin Ave, Suite 1660, Chevy Chase, MD 20815 | 2014-04-16 |
| 1750703864 | Koman Orthopedics and Sports Medicine, LLC | Orthopaedic Surgery | 116 Westminster Pike, Suite 100, Reisterstown, MD 21136-1027 | 2014-01-08 |
| 1962766899 | Precision Orthpedics and Sports Medicine | Orthopaedic Surgery | 14201 Park Center Dr, Suite 410, Laurel, MD 20707-5217 | 2012-06-26 |
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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.