Virginia L Wallace (NPI# 1205861606, PAC ID# 2668441809) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PATHOLOGY.
| Nation Provider ID (NPI) | 1205861606 |
| PAC ID by PECOS | 2668441809 |
| Professional Enrollment ID | I20040924001070 |
| Full Name | Virginia L Wallace |
| Organization Legal Name | GREAT LAKES PATHOLOGISTS SC |
| Address |
1032 E Sumner St Aurora Medical Center Hartford Hartford WI 53027-1608 |
| Phone Number | 2626707231 |
| Gender | F |
| Credential | MD |
| Medical School | MEDICAL COLLEGE OF GEORGIA |
| Graduation Year | 1993 |
| Primary Specialty | PATHOLOGY |
| Group Practice PAC ID | 7315850682 |
| Number of Group Practice Members | 53 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 520138 | AURORA ST LUKES MEDICAL CENTER |
| 520008 | WAUKESHA MEMORIAL HOSPITAL |
| 520193 | AURORA BAYCARE MEDICAL CENTER |
| 520189 | AURORA MEDICAL CENTER KENOSHA |
| 520139 | WEST ALLIS MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 252 Mchenry St, Burlington, WI 53105-1828 | 2627676125 | GREAT LAKES PATHOLOGISTS SC |
| 5900 S Lake Dr, Cudahy, WI 53110-3171 | 4144894121 | GREAT LAKES PATHOLOGISTS SC |
| 1032 E Sumner St, Aurora Medical Center Hartford, Hartford, WI 53027-1608 | 2626707231 | GREAT LAKES PATHOLOGISTS SC |
| 2900 W Oklahoma Ave, Aurora St Luke's Medical Center, Milwaukee, WI 53215-4330 | 4146497338 | GREAT LAKES PATHOLOGISTS SC |
| 2629 N 7th St, Aurora Sheboygan Memorial Medical C, Sheboygan, WI 53083-4932 | 9204515699 | GREAT LAKES PATHOLOGISTS SC |
| 36500 Aurora Dr, Summit, WI 53066-4899 | 2624345000 | GREAT LAKES PATHOLOGISTS SC |
| 8901 W Lincoln Ave, West Allis Memorial Hospital, West Allis, WI 53227-2409 | 4143287950 | GREAT LAKES PATHOLOGISTS SC |
| Organization Legal Name | GREAT LAKES PATHOLOGISTS SC |
| Physicians | 55 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Shanon R Lacy | Pathology | Great Lakes Pathologists Sc | 2629 N 7th St, Aurora Sheboygan Memorial Medical C, Sheboygan, WI 53083-4932 |
| Ross A Worthington | Pathology | Great Lakes Pathologists Sc | 975 Port Washington Rd, Aurora Medical Center Grafton, Grafton, WI 53024-9201 |
| Matthew L Snyder | Pathology | Great Lakes Pathologists Sc | 975 Port Washington Rd, Aurora Medical Center Grafton, Grafton, WI 53024-9201 |
| Amanda L Wilson | Pathology | Great Lakes Pathologists Sc | 2629 N 7th St, Aurora Sheboygan Memorial Medical C, Sheboygan, WI 53083-4932 |
| Elizabeth Mae Fowler | Pathology | Great Lakes Pathologists Sc | 8901 W Lincoln Ave, West Allis Memorial Hospital, West Allis, WI 53227-2409 |
| Amanda L Meindl | Pathology | Great Lakes Pathologists Sc | 8901 W Lincoln Ave, West Allis Memorial Hospital, West Allis, WI 53227-2409 |
| Margaret M Anderson | Pathology | Great Lakes Pathologists Sc | 975 Port Washington Rd, Aurora Medical Center Grafton, Grafton, WI 53024-9201 |
| Sherri J Mann | Pathology | Great Lakes Pathologists Sc | 8901 W Lincoln Ave, West Allis Memorial Hospital, West Allis, WI 53227-2409 |
| Karin L Gerdisch | Pathology | Great Lakes Pathologists Sc | 8901 W Lincoln Ave, West Allis Memorial Hospital, West Allis, WI 53227-2409 |
| Michael G Tresp | Pathology | Great Lakes Pathologists Sc | 2629 N 7th St, Aurora Sheboygan Memorial Medical C, Sheboygan, WI 53083-4932 |
| Street Address |
1032 E SUMNER ST AURORA MEDICAL CENTER HARTFORD |
| City | HARTFORD |
| State | WI |
| Zip | 53027-1608 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amir Daniel | Nephrology | Midwest Nephrology Associates, S.c. | 1032 E Sumner St, Hartford Memorial Hospital, Hartford, WI 53027-1608 |
| Marianna M Herrera | Certified Registered Nurse Anesthetist (crna) | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Antony V George | Emergency Medicine | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Kimberly A Marshall | Physician Assistant | Advanced Pain Management Sc | 1032 E Sumner St, Hartford, WI 53072-1608 |
| Nagarjun Rao | Pathology | Great Lakes Pathologists Sc | 1032 E Sumner St, Aurora Medical Center Hartford, Hartford, WI 53027-1608 |
| Lori L Mcallister | Undersea and Hyperbaric Medicine | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Aurora M Lybeck | Emergency Medicine | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Sarah S Silver | Emergency Medicine | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Douglas D Chausow | Pathology | Great Lakes Pathologists Sc | 1032 E Sumner St, Aurora Medical Center Hartford, Hartford, WI 53027-1608 |
| Joseph R James | Emergency Medicine | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jacob Valabov | Podiatry | Preferred Podiatry Group PC | 112 Peace Lutheran Pkwy, Hartford, WI 53027-1159 |
| Kenneth V Schmidt | Clinical Social Worker | Wisconsin Lutheran Child and Family Service Inc | 112 Peace Lutheran Pkwy, Hartford, WI 53027-1159 |
| Jeremy M Katz | Clinical Psychologist | 1202 E Sumner St, Hartford, WI 53027-1600 | |
| David J Schimp | Chiropractic | 937 E Sumner St, Hartford, WI 53027-1605 | |
| Amber L Widenski | Emergency Medicine | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Janet R Durham | Pathology | Great Lakes Pathologists Sc | 1032 E Sumner St, Aurora Medical Center Hartford, Hartford, WI 53027-1608 |
| Katherine M Karczewski | Nurse Practitioner | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Sandra A French | Anesthesiology | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Syed I Karim | Emergency Medicine | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Lisa Marie Bullis | Nurse Practitioner | Aurora Medical Group Inc | 1032 E Sumner St, Hartford, WI 53027-1608 |
| Find all physicians in zip 53027 | |||
| City | HARTFORD |
| Zip Code | 53027 |
| Specialty | PATHOLOGY |
| City + Specialty | HARTFORD + PATHOLOGY |
Please comment or provide details below to improve the information on Virginia L Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.