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
Phone: (540) 825-6100
Fax: (540) 825-1829
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487679627 | NPPES |
| Virginia | MEDICAID | 005624339 |
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