GONZALO WALLIS (NPI# 1417179078) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417179078 |
| Entity Type | Individual |
| Full Name | GONZALO WALLIS |
| Credential | MD |
| Practice Address |
1001 Blythe Blvd Ste 200d Charlotte NC 28203-5866 |
| Mailing Address |
Po Box 19305 Charlotte NC 28219-9305 |
| Practice Telephone | 7043731813 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-09-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
2013-02269 | NC | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 134 Medical Park Rd, Ste 111 - Adult Cardiology, Mooresville, NC 281178526 | 7048019100 | |
| 100 Medical Park Dr, Ste 310, Concord, NC 280252948 | 7043730212 | |
| 129 Woodson St, Pediatric Cardiology, Salisbury, NC 281443255 | 7043730212 | |
| 1781 Tate Blvd Se, Ste 203, Hickory, NC 286024251 | 7043730212 |
| Street Address |
1001 BLYTHE BLVD STE 200D |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28203-5866 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699771790 | Markus Scherer | Internal Medicine | 1001 Blythe Blvd, Ste 300- Adult Cardiology, Charlotte, NC 28203-5866 | 2005-06-23 |
| 1194334417 | Sarah Hargett | Nurse Practitioner | 1001 Blythe Blvd, Medical Center Plaza Suite 200, Charlotte, NC 28203-5866 | 2020-07-23 |
| 1457985129 | Laura Abramo | Nurse Practitioner | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2020-03-02 |
| 1497388490 | Jessica Gallimore | Nurse Practitioner | 1001 Blythe Blvd, Ste 300 - Cardiac Surgery, Charlotte, NC 28203-5866 | 2020-02-18 |
| 1821620451 | Kevin Wagner | Nurse Practitioner | 1001 Blythe Blvd, Ste 300- Adult Cardiology, Charlotte, NC 28203-5866 | 2020-02-11 |
| 1336771666 | Jahaziel Rendon | Physician Assistant | 1001 Blythe Blvd, Ste 300 - Thoracic Surgery, Charlotte, NC 28203-5866 | 2020-02-05 |
| 1619508629 | Yolanda Cousen | Nurse Practitioner | 1001 Blythe Blvd, Ste 300 - Thoracic Surgery, Charlotte, NC 28203-5866 | 2020-01-29 |
| 1316597115 | Devan Herring | Dietitian, Registered | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2019-09-13 |
| 1194374793 | Catherine Shah | Nurse Practitioner | 1001 Blythe Blvd, Ste 300- Adult Cardiology, Charlotte, NC 28203-5866 | 2019-09-05 |
| 1710535786 | Cynthia Ann Klotz | Pharmacist | 1001 Blythe Blvd, Medical Center Plaza, Suite 601, Charlotte, NC 28203 | 2019-09-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982225983 | William Bedard Michel | Emergency Medicine | Carolina Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203 | 2020-04-30 |
| 1922636927 | Paulina M Kriska | Dentist | Cmc Dental Clinic, 1000 Blythe Blvd, Charlotte, NC 28203 | 2020-03-27 |
| 1386271930 | Irina Maria Geiculescu | Pediatrics | 1000 Blythe Blvd Fl 4 Meb, Charlotte, NC 28203 | 2020-03-24 |
| 1205499316 | James C Winnek | Counselor | 1713 East Blvd., Charlotte, NC 28203 | 2019-04-16 |
| 1487114492 | Laurie Fford Counseling and Consulting Pllc | Counselor | 125 Remount Rd, Suite C-#391, Charlotte, NC 28203 | 2019-03-25 |
| 1184188815 | Sunday Money | Home Health | 2151 Hawkins St., Suite 201, Charlotte, NC 28203 | 2019-01-28 |
| 1164902706 | Lindsay Koonce Helton | Dietitian, Registered | 1218 East Blvd Ste G, Charlotte, NC 28203 | 2018-08-14 |
| 1376057406 | Veritas Collaborative Charlotte, LLC | Clinic/Center | 1900 Scott Avenue, Suite 101, Charlotte, NC 28203 | 2017-11-28 |
| 1043733306 | Kimberly Stripp | Pharmacist | 1300-b East Blvd, Charlotte, NC 28203 | 2017-07-19 |
| 1427570639 | Caroline Kaleel Fogleman | Optometrist | 1710 Kenilworth Ave Ste 210, Charlotte, NC 28203 | 2017-07-10 |
| Find all providers in zip 28203 | ||||
| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| 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 Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952626376 | Carolinas Physicians Network, Inc. | Pediatrics | 14214 Ballantyne Lake Road, Suite 150, Charlotte, NC 28277-3373 | 2010-03-29 |
| 1114152469 | Frances Chen Travelli | Pediatrics | 1718 E 4th St Ste 605, Charlotte, NC 28204-3282 | 2009-05-15 |
| 1861978785 | Novant Medical Group, Inc. | Pediatrics | 6331 Carmel Rd Ste 102, Charlotte, NC 28226-8246 | 2018-07-13 |
| 1306117346 | Jennifer Bailey | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2012-01-23 |
| 1730409046 | Aaron Prosnitz | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2010-06-09 |
| 1881919306 | Carolinas Physicians Network, Inc. | Pediatrics | 1000 Blythe Blvd Fl 4, Charlotte, NC 28203-5812 | 2010-03-29 |
| 1639339450 | Matthew Brothers | Pediatrics | 1718 E 4th St, Suite 605, Charlotte, NC 28204-3261 | 2008-06-16 |
| 1811068281 | James Herlong | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2006-11-10 |
| 1659382059 | William Wallace Hammill | Pediatrics | 1718 E 4th St, Suite 401, Charlotte, NC 28204-3261 | 2006-08-10 |
| 1659387280 | Andrew Bensky | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2006-08-01 |
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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.