Wallace, Matthew Brevard

Wallace, Matthew Brevard is an individual health care provider with primary practice located at 1200 Sunset Ln Ste 2210 , Culpeper VA 22701-3376. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wallace, Matthew Brevard can be contacted via phone (540) 825-6100.

Contact Information

Primary practice address
1200 Sunset Ln Ste 2210 Culpeper VA 22701-3376
Fax: (540) 825-1829
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0101025059 Virginia

Profile Details

NPI number 1487679627
LBN Legal business name Wallace, Matthew Brevard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2006
Last updated Mar 29th, 2013 - about 13 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 1487679627 NPPES
Virginia MEDICAID 005624339

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