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
Phone: (443) 904-6999
Fax:
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1801864350 | NPPES |
| Maryland | MEDICAID | 372141800 |
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