THOMAS MARK WALLACE (NPI# 1114912011) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114912011 |
| Entity Type | Individual |
| Full Name | THOMAS MARK WALLACE |
| Credential | MD |
| Practice Address |
160 Wyoming St Dayton OH 45409-2740 |
| Mailing Address |
Po Box 20452 Vpi Cred Columbus OH 43220-0452 |
| Practice Telephone | 9372249326 |
| Practice Fax Number | 9372241010 |
| Mailing Telephone | 6144422406 |
| Mailing Fax Number | 6144422410 |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2015-11-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ZC0500X |
Pathology Specialization: Cytopathology |
35061202W | OH | Allopathic & Osteopathic Physicians |
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
35061202 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | RR MEDICARE | 220018843 | 01 |
| OH | 0828939 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124021696 | Thomas R Wallace | Ophthalmology | 211 Mcauley Ct, Hot Springs, AR 71913-6314 | 2005-05-27 |
| 1316547342 | Thomas E Wallace IIi | Pharmacist | 1571 Forest Ave, Staten Island, NY 10302-2226 | 2020-10-28 |
| 1023499217 | Thomas Wallace | Massage Therapist | 17205 Vashon Hwy Sw, Suite B2, Vashon, WA 98070-4674 | 2015-06-12 |
| 1275945354 | Thomas Wallace Jr. | Counselor | 1646 S Court St, Visalia, CA 93277-4962 | 2014-05-23 |
| 1265787147 | Thomas Danville Wallace | Pharmacy Technician | 215 Dexter L Woods Memorial Blvd, Waynesboro, TN 38485-2416 | 2012-07-17 |
| 1386789147 | Thomas W Wallace | Psychiatry & Neurology | 180 Grand Ave Ste 100, Oakland, CA 94612-3766 | 2007-02-20 |
| 1801942933 | Thomas Clyde Wallace | Psychiatry & Neurology | 10 Congress St, Suite 360, Pasadena, CA 91105-3023 | 2007-01-25 |
| 1679641666 | Thomas M Wallace | Internal Medicine | 1441 Florida Ave, Modesto, CA 95350-4405 | 2006-11-30 |
| 1295807733 | Thomas Witherspoon Wallace | Internal Medicine | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2006-11-13 |
| 1639251416 | Thomas A Wallace | Social Worker | 254 N Washington St, Falls Church, VA 22046-4517 | 2006-10-20 |
| Street Address |
160 WYOMING ST |
| City | DAYTON |
| State | OH |
| Zip Code | 45409-2740 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437151214 | Steven Douglas Kilian | Specialist | 160 Wyoming St, Dayton, OH 45409-2740 | 2005-08-11 |
| 1295854271 | John R Bullmaster Md Inc | Surgery | 160 Wyoming St, Suite 1, Dayton, OH 45409-2740 | 2007-03-28 |
| 1033268610 | Steven L Rura | Spec/Tech, Pathology | 160 Wyoming St, Dayton, OH 45409-2740 | 2007-01-10 |
| 1386793024 | Emily Ann Mohammad | Spec/Tech, Pathology | 160 Wyoming St, Dayton, OH 45409-2740 | 2007-01-10 |
| 1043369606 | Donald Larue Austin | Spec/Tech, Pathology | 160 Wyoming St, Dayton, OH 45409-2740 | 2007-01-10 |
| 1720137458 | Donald Angle | Spec/Tech, Pathology | 160 Wyoming St, Dayton, OH 45409-2740 | 2007-01-10 |
| 1427106889 | Katrina St. Clair | Spec/Tech, Pathology | 160 Wyoming St, Dayton, OH 45409-2740 | 2007-01-08 |
| 1639124175 | Health Specialists of Dayton Inc | Obstetrics & Gynecology | 160 Wyoming St, Dayton, OH 45409-2740 | 2006-05-23 |
| 1356327266 | John Bullmaster | Surgery | 160 Wyoming St, Suite 1, Dayton, OH 45409-2740 | 2005-12-22 |
| 1457348625 | Nola J. Palomino | Pathology | 160 Wyoming St, Dayton, OH 45409-2740 | 2005-10-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487276457 | Matthew R Schaeffer | Surgery | 128 E Apple St., Wche 7th Floor, Dayton, OH 45409 | 2020-05-13 |
| 1699237545 | Elizabeth Joan Hudson | Student in an Organized Health Care Education/Training Program | 1 Wyoming Street Miami Valley Hospital Medical Educatio, Dayton, OH 45409 | 2019-04-01 |
| 1760941066 | Courtney Lyn Johnson | Surgery | 128 East Apple Street, Wche 7th Floor, Dayton, OH 45409 | 2019-03-16 |
| 1477057529 | Adam Joseph Langer | Student in an Organized Health Care Education/Training Program | 128 E. Apple St Suite 3800, Wright State University Dept of Ob/gyn, Dayton, OH 45409 | 2018-03-22 |
| 1659870939 | Timothy Wall | Student in an Organized Health Care Education/Training Program | 128 East Apple St., 2nd Floor, Dayton, OH 45409 | 2018-02-01 |
| 1124551411 | Adam Schmerge Deardorff | Student in an Organized Health Care Education/Training Program | 30 E Apple St Ste 6257, Dayton, OH 45409 | 2017-04-04 |
| 1205205358 | Kelby Snorf | Physician Assistant | 30 E Apple Street, Suite 3300, Dayton, OH 45409 | 2015-09-18 |
| 1689054223 | Jessica Ezinne Ugwu | Family Medicine | 30 E Apple St., Suite Nw 3300, Dayton, OH 45409 | 2015-06-08 |
| 1679983084 | Jude Anneryan Cohen | Registered Nurse | 1200 W. Dorothy Lane, Southdale Elementary School, Kettering, OH 45409 | 2014-05-07 |
| 1730517087 | Jesse Wayne Clark | Counselor | 65 Grady Ct, Dayton, OH 45409 | 2013-10-24 |
| Find all providers in zip 45409 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437353745 | Raymond C Wong | Pathology | Division of Pathology, Childrens' Medical Center, 1 Children's Plaza, Dayton, OH 45404-1815 | 2007-06-12 |
| 1518950476 | Cytology Associates of Dayton, Inc. | Pathology | 11 S Main St, Dayton, OH 45402-2024 | 2005-08-25 |
| 1598767758 | Edward Ewing | Pathology | 405 W Grand Ave, Dayton, OH 45405-4720 | 2005-06-01 |
| 1356715767 | Emily Raftopoulos | Pathology | 4100 W 3rd St, Dayton, OH 45428-9000 | 2015-11-23 |
| 1952716276 | Jacob Collie | Pathology | 4881 Sugar Maple Dr, Dayton, OH 45433-5529 | 2014-06-25 |
| 1699186445 | Sergei Rafael Guma | Pathology | 1 Wyoming St, Dayton, OH 45409-2722 | 2014-05-14 |
| 1760779300 | Hope Elizabeth Karnes | Pathology | 1 Wyoming St, Valley Pathologists, Inc., Dayton, OH 45409-2722 | 2011-07-04 |
| 1043509250 | Michael Benjamin Gentry | Pathology | 3535 Southern Blvd, Dayton, OH 45429 | 2011-03-29 |
| 1760626881 | Megan Christine Smith | Pathology | 1 Wyoming St, Dayton, OH 45409-2722 | 2009-04-21 |
| 1205097193 | Baojin Fu | Pathology | 1 Wyoming St, Dayton, OH 45409-2722 | 2008-06-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.