Wallace, Brian

Wallace, Brian is an sole proprietor health care provider with primary practice located at 9005 Kilbride Rd , Baltimore MD 21236-2017. He recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as his primary health care specialty. Wallace, Brian can be contacted via phone (443) 904-6999.

Contact Information

Primary practice address
9005 Kilbride Rd Baltimore MD 21236-2017
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X D31136 Maryland

Profile Details

NPI number 1801864350
LBN Legal business name Wallace, Brian
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 10th, 2006
Last updated Feb 28th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801864350 NPPES
Maryland MEDICAID 372141800

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