LYDIA WALLACE (NPI# 1417344581) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417344581 |
| Entity Type | Individual |
| Full Name | LYDIA WALLACE |
| Practice Address |
101 Hospital Loop Ne Albuquerque NM 87109-2129 |
| Mailing Address |
20 York St New Haven CT 06510-3220 |
| Practice Telephone | 6159286268 |
| Mailing Telephone | 2036884242 |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2020-05-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | MD2019-0840 | NM | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | LICENSE | MD2019-08 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 145 Harrison Ave, Sackler Center 4th Floor, Boston, MA 021111802 | 1617636656 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215139381 | Lydia Valladares Wallace | Family Medicine | 131 S Citrus Ave, Inverness, FL 34452-4701 | 2007-06-01 |
| Street Address |
101 HOSPITAL LOOP NE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87109-2129 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578567962 | Barry James Beaven | Family Medicine | 101 Hospital Loop Ne, Ste 109, Albuquerque, NM 87109-2129 | 2005-06-13 |
| 1992131916 | Atrinea Health LLC | Family Medicine | 101 Hospital Loop Ne, Suite 109, Albuquerque, NM 87109-2129 | 2013-09-23 |
| 1063848422 | Sarah Elizabeth Kabalka | Nurse Practitioner | 101 Hospital Loop Ne, Suite 114, Albuquerque, NM 87109 | 2013-09-17 |
| 1528399342 | Bonnie G. Miller, Lpcc, PC | Clinic/Center | 101 Hospital Loop Ne, Suite 215, Albuquerque, NM 87109-2129 | 2010-01-18 |
| 1700014479 | Sandia Neurology PC | Psychiatry & Neurology | 101 Hospital Loop Ne, Suite 111, Albuquerque, NM 87109-2129 | 2009-07-01 |
| 1932337557 | Angela L Drury PC | Podiatrist | 101 Hospital Loop Ne, Suite 115, Albuquerque, NM 87109-2129 | 2009-06-23 |
| 1770724916 | David C Leech Do Inc PC | Family Medicine | 101 Hospital Loop Ne, Suite 114, Albuquerque, NM 87109-2129 | 2009-03-18 |
| 1467691022 | Albuquerque Neuroscience, Inc. | Exclusive Provider Organization | 101 Hospital Loop Ne, Suite 209, Albuquerque, NM 87109-2129 | 2009-02-05 |
| 1114165719 | Glenn Michael Dempsey | Psychiatry & Neurology | 101 Hospital Loop Ne, Suite 209, Albuquerque, NM 87109-2129 | 2009-02-04 |
| 1942498142 | Rosalind Epstein Md Professional Corporation | Orthopaedic Surgery | 101 Hospital Loop Ne, Suite 113, Albuquerque, NM 87109-2129 | 2007-10-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386286367 | Mikaela Epaloose | Behavior Technician | 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-10-11 |
| 1245872464 | Marsha Director | Behavior Technician | 100 Sun Avenue Ne, Ste 650, Albuquerque, NM 87109 | 2019-10-09 |
| 1720637499 | Nancy Gail Vice | Technician | 7319 Laguna Niguel Drive Ne, Albuquerque, NM 87109 | 2019-09-05 |
| 1598314411 | Chau Vu | Behavior Technician | Attn: Behavioral Health Works 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-09-04 |
| 1932753498 | Noelle Nielsen | Behavior Technician | 6401 Academy Rd. Ne Apt. 189, Albuquerque, NM 87109 | 2019-08-01 |
| 1952967952 | Caridad Merkel | Obstetrics & Gynecology | 6100 Pan American Fwy Ne Suite 450, Albuquerque, NM 87109 | 2019-05-15 |
| 1043795149 | Margaret Mcconville | Physical Therapist | Lovelace Women's Hospital Outpatient Rehabilitation, 4600 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-09-25 |
| 1922586262 | Clark Endodontics LLC | Dentist | 7520 Montgomery Blvd Ne Bldg E1, Albuquerque, NM 87109 | 2018-07-30 |
| 1447736202 | Melissa Christine Scott | Registered Nurse | Lovelace Women's Hospital, 4701 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-07-16 |
| 1508351990 | Gianna Nicole Casarez-quintana | Dentist | 7520 Montgomery Blvd Ne Bldg E10, Albuquerque, NM 87109 | 2018-06-27 |
| Find all providers in zip 87109 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730612359 | Adam Michael Tolar | Emergency Medicine | Mcs 11 6025, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2017-04-10 |
| 1538691712 | David Scott Fischman | Emergency Medicine | 6400 Paseo Del Norte Blvd Ne, Albuquerque, NM 87113-8711 | 2017-03-28 |
| 1265895486 | Nedda Fariba Karimi | Emergency Medicine | 4515 Coors Blvd Nw, Albuquerque, NM 87120-3699 | 2016-04-04 |
| 1417310764 | Justin Itty Mathew | Emergency Medicine | Department of Emergency Medicine Msc11 6025, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2016-04-04 |
| 1639532583 | Amanda Lauren Ventura | Emergency Medicine | Msc Emergency Medicine 1 University of New Mexico, Albuquerque, NM 87131-2364 | 2016-03-29 |
| 1083000178 | David Michael Glass | Emergency Medicine | Emergency Medicine Msc 11 6025, University of New Mexico, Albuquerque, NM 87131-0001 | 2015-04-15 |
| 1952797300 | Eleni Marie Bucuvalas | Emergency Medicine | Msc 11-6025, 1 University of New Mexico, Albuquerque, NM 87131 | 2015-04-13 |
| 1225423239 | Joseph Smith Jr. | Emergency Medicine | Msc 11 6025 University of New Mexico, Albuquerque, NM 87131-0001 | 2015-04-06 |
| 1073932471 | Kimberly Marie Ruth Pruett | Emergency Medicine | Unm Department of Emergency Medicine 1 Unm, Albuquerque, NM 87131-4700 | 2014-04-14 |
| 1538509484 | Jason S. Zeller | Emergency Medicine | Msc 11 6025 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2013-06-25 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87109 |
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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.