Wallace, Charles W

Wallace, Charles W is an individual health care provider with primary practice located at 4455 Dressler Rd Nw , Canton OH 44718-2785. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wallace, Charles W can be contacted via phone (330) 497-6555.

Contact Information

Primary practice address
4455 Dressler Rd Nw Canton OH 44718-2785
Phone: (330) 497-6555
Fax: (330) 497-3281
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 70831 Minnesota
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 35080468W Ohio

Profile Details

NPI number 1780652792
LBN Legal business name Wallace, Charles W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2006
Last updated Apr 30th, 2024 - about last year

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 1780652792 NPPES
Ohio MEDICAID 2374014
Ohio Other 1074
Ohio Other 733074
Ohio Other 000000189519
Ohio Other 000000490965
Ohio Other Q016786D

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