Jennifer Wallace (NPI# 1821597881, PAC ID# 3971866591) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1821597881 |
| PAC ID by PECOS | 3971866591 |
| Professional Enrollment ID | I20190429000726 |
| Full Name | Jennifer Wallace |
| Organization Legal Name | MERIDIAN PRIMARY CARE LLC |
| Address |
115 N Bridge St Elkton MD 21921-5326 |
| Phone Number | 4103983041 |
| Gender | F |
| Graduation Year | 2017 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 2365536695 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 210032 | UNION HOSPITAL OF CECIL COUNTY |
| Address | Phone | Organization |
|---|---|---|
| 115 N Bridge St, Elkton, MD 21921-5326 | 4103983041 | MERIDIAN PRIMARY CARE LLC |
| Organization Legal Name | MERIDIAN PRIMARY CARE LLC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Carlo E Gopez | Family Medicine | Meridian Primary Care LLC | 115 N Bridge St, Elkton, MD 21921-5326 |
| Helene Lee | Family Medicine | Meridian Primary Care LLC | 115 N Bridge St, Elkton, MD 21921-5326 |
| Street Address |
115 N BRIDGE ST |
| City | ELKTON |
| State | MD |
| Zip | 21921-5326 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Carlo E Gopez | Family Medicine | Meridian Primary Care LLC | 115 N Bridge St, Elkton, MD 21921-5326 |
| Helene Lee | Family Medicine | Meridian Primary Care LLC | 115 N Bridge St, Elkton, MD 21921-5326 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Steven Craig Kunkel Jr. | Physical Therapy | Ati Holdings LLC | 9 S Bridge St, Commercial Plaza, Elkton, MD 21921 |
| Bonni B Roberts | Family Medicine | Fairhill Family Medicine Specialists, LLC | 361 Fair Hill Dr, Elkton, MD 21921-2512 |
| Vanessa V Villar | Family Medicine | Fairhill Family Medicine Specialists, LLC | 361 Fair Hill Dr, Elkton, MD 21921-2512 |
| Frances R Klaff | Clinical Psychologist | 112 Dennis Dr, Elkton, MD 21921-2970 | |
| Carolyn J King | Clinical Social Worker | Upper Bay Counseling and Support Services, Inc. | 1275 W Pulaski Hwy, Elkton, MD 21921-4719 |
| Deborah K Dalrymple | Clinical Social Worker | Upper Bay Counseling and Support Services, Inc. | 1275 W Pulaski Hwy, Elkton, MD 21921-4719 |
| Lynanne Romano | Psychologist, Clinical | Upper Bay Counseling and Support Services, Inc. | 1275 W Pulaski Hwy, Elkton, MD 21921-4719 |
| Michelle W Sayre | Clinical Social Worker | Upper Bay Counseling and Support Services, Inc. | 1275 W Pulaski Hwy, Elkton, MD 21921-4719 |
| Paul A. Gianakon | Psychiatry | Upper Bay Counseling and Support Services, Inc. | 1275 W Pulaski Hwy, Elkton, MD 21921-4719 |
| Sharon Stephenson | Clinical Social Worker | Upper Bay Counseling and Support Services, Inc. | 1275 W Pulaski Hwy, Elkton, MD 21921-4719 |
| Find all physicians in zip 21921 | |||
| City | ELKTON |
| Zip Code | 21921 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | ELKTON + NURSE PRACTITIONER |
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| 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.