CHARLES A. WALL (NPI# 1164528725) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164528725 |
| Entity Type | Individual |
| Full Name | CHARLES A. WALL |
| Credential | MD |
| Practice Address |
455 Grand Ave South San Francisco CA 94080-3635 |
| Mailing Address |
2001 Union St Suite 300 San Francisco CA 94123-4114 |
| Practice Telephone | 6506361286 |
| Practice Fax Number | 6505884164 |
| Mailing Telephone | 4154476899 |
| Mailing Fax Number | 4154476894 |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
G3564 | CA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376985655 | Charles Coleman Wall | Dentist | 2200 E 4500 S, Suite 240, Salt Lake City, UT 84117-4437 | 2013-07-26 |
| 1013178128 | Charles Earl Wall Jr. | Physician Assistant | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2008-06-20 |
| 1073717955 | Charles Edward Wall Jr. | Surgery | 102 Doctors Park, Starkville, MS 39759 | 2007-06-13 |
| 1770792871 | Charles Ray Wall | Pharmacist | 727 Memorial Dr, Bessemer, AL 35022-6029 | 2007-05-22 |
| Street Address |
455 GRAND AVE |
| City | SOUTH SAN FRANCISCO |
| State | CA |
| Zip Code | 94080-3635 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427008135 | Wall Medical Group | Ophthalmology | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2006-05-11 |
| 1386978542 | Anna Marie Maagdenberg | Nurse Practitioner | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2009-09-21 |
| 1134294416 | Coastside Clinical Laboratory | Clinical Medical Laboratory | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2006-11-21 |
| 1598861569 | Luis F Montalvo | Obstetrics & Gynecology | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2006-09-16 |
| 1740386309 | Wall Medical Inc | Clinical Medical Laboratory | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2006-09-14 |
| 1649376211 | Donald Richard Dossett | Family Medicine | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2006-09-14 |
| 1629174271 | Pmc Laboratory Services A Medical Group | Clinical Medical Laboratory | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2006-09-14 |
| 1851309983 | North Bay Rehabilitation | Physical Therapist | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2006-08-04 |
| 1679516488 | Catherine Wall | Physical Therapist | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2006-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245704303 | Patricia Sweeney | Nurse Practitioner | 435 Gran Ave, South San Francisco, CA 94080 | 2019-01-11 |
| 1518446988 | Yessenia Patricia Pena Ruiz | Counselor | 117 Pecks Ln, South San Francisco, CA 94080 | 2018-08-07 |
| 1982112579 | Breanna Mottau | Behavioral Analyst | 751a Camino Plaza, San Bruno, CA 94080 | 2018-01-17 |
| 1720594294 | Patricia Lynn Jasper | Nurse Practitioner | 395 Oyster Point Blvd., Suite 128, South San Francisco, CA 94080 | 2017-12-20 |
| 1184146755 | Breanne Ho | Student in an Organized Health Care Education/Training Program | 130 Nursery Way, South San Francisco, CA 94080 | 2017-07-14 |
| 1568843787 | Lita Wu | Optometrist | 119 Hickey Blvd, South San Francisco, CA 94080 | 2015-06-12 |
| 1720479553 | Naf Nasser Almadari | Physician Assistant | 717 Baden Ave, San Francisco, CA 94080 | 2015-02-16 |
| 1528459351 | Alexander M Gold | Internal Medicine | 270 East Grand Avenue, South San Francisco, CA 94080 | 2015-02-16 |
| 1548673411 | Elite Care Home Health Agency, Inc. | Home Health | 91 Westborough Blvd Ste 2020, South San Francisco, CA 94080 | 2014-06-08 |
| 1720415979 | Optometry Eyecareeyewear Com Inc | Optometrist | 601 Gateway Blvd., Suite 220, South San Francisco, CA 94080 | 2013-10-02 |
| Find all providers in zip 94080 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710065321 | Gregory C. Lukaszewicz | Surgery | 1200 El Camino Real, South San Francisco, CA 94080-3208 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881213817 | Robert Morton Carroll X | Surgery | 2241 Century Hl, Los Angeles, CA 90067-3506 | 2020-04-09 |
| 1992341895 | Surgicalist of Ca PC | Surgery | 3300 E South St Ste 301a, Lakewood, CA 90805-4549 | 2019-11-26 |
| 1528600558 | Kevin M Casey Md Apmc | Surgery | 1919 State St # 204-206, Santa Barbara, CA 93101-2430 | 2019-10-10 |
| 1487117594 | John Nastasi | Surgery | 100 W Valencia Mesa Dr # 211, Fullerton, CA 92835-3768 | 2019-04-08 |
| 1225508385 | Jay Labourene | Surgery | 1550 G Tiburon Blvd, Tiburon, CA 94920-2531 | 2018-12-03 |
| 1467922120 | Paul Bressman Md Inc | Surgery | 1493 S Crest Dr, Los Angeles, CA 90035-3339 | 2018-11-26 |
| 1437638517 | Thousand Oaks Vein Clinic PC | Surgery | 225 N Moorpark Rd Ste C, Thousand Oaks, CA 91360-4320 | 2018-08-09 |
| 1881186377 | Lavs Access Center Inc. | Surgery | 620 W Beverly Blvd Ste B, Montebello, CA 90640-3624 | 2018-05-31 |
| 1841789328 | Sunil Rayan, M.d., Inc. | Surgery | 320 Santa Fe Dr Ste 212, Encinitas, CA 92024-5139 | 2018-05-09 |
| 1245739820 | Northridge Vascular Center A Professional Medical Corporation | Surgery | 19331 Business Center Dr Ste 102, Northridge, CA 91324-3533 | 2018-02-08 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH SAN FRANCISCO |
| Zip Code | 94080 |
Please comment or provide details below to improve the information on CHARLES A. WALL.
| 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.