DR. ERIC L. WALLACE (NPI# 1780614529) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780614529 |
| Entity Type | Individual |
| Full Name | DR. ERIC L. WALLACE |
| Credential | M.D. |
| Practice Address |
1450 Matthews Township Parkway Suite 300 Matthews NC 28105 |
| Mailing Address |
1918 Randolph Road Suite 130 Charlotte NC 28207-1107 |
| Practice Telephone | 7048411444 |
| Practice Fax Number | 7048492520 |
| Mailing Telephone | 7043648100 |
| Mailing Fax Number | 7043652073 |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2010-02-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 2006-00806 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5904040 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417183476 | Eric T Wallace | Physical Therapist | W5361 County Road Kk Ste E, Appleton, WI 54915-7271 | 2009-06-04 |
| 1922218809 | Eric Wallace | Radiologic Technologist | 4004 Landside Dr, Louisville, KY 40220-3020 | 2007-05-22 |
| 1871706960 | Eric Wallace | Emergency Medicine | Paula Bldg 230, 728 Richard Arrington Blvd, Birmingham, AL 35294-0001 | 2007-05-07 |
| 1174665277 | Eric H Wallace | Dentist | 28 Se 6th St, Boca Raton, FL 33432-6016 | 2007-02-13 |
| 1912409160 | Eric Wallace | Psychologist | 22001 Fairmount Blvd, Shaker Heights, OH 44118-4819 | 2018-03-05 |
| 1528333838 | Eric Joseph Wallace Jr. | Radiology | 1542 Tulane Ave, Room 353, New Orleans, LA 70112-2865 | 2012-03-20 |
| 1568658243 | Eric L Wallace | Internal Medicine | 700 W Ironwood Dr, 320, Coeur D Alene, ID 83814-2656 | 2007-09-17 |
| 1891838991 | Eric Michael Wallace | Dentist | 1515 State St, Suite 9, Santa Barbara, CA 93101-2536 | 2007-02-15 |
| 1154434488 | Eric Wallace | Family Medicine | 143 Longwater Dr, Norwell, MA 02061-1683 | 2006-08-17 |
| 1578502191 | Eric Wallace | Radiology | 168 N Brent St, Suite 402, Ventura, CA 93003-2817 | 2006-06-06 |
| Street Address |
1450 MATTHEWS TOWNSHIP PARKWAY SUITE 300 |
| City | MATTHEWS |
| State | NC |
| Zip Code | 28105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114366994 | Novant Medical Group Inc | Neurological Surgery | 1450 Matthews Township Parkway, Suite 355, Matthews, NC 28105-4300 | 2013-06-14 |
| 1639480569 | Peter S Salib | Obstetrics & Gynecology | 1450 Matthews Township Parkway, Suite 300, Matthews, NC 28105-5332 | 2010-06-25 |
| 1497978837 | Samuel Stuart Dupuy Jr. | Urology | 1450 Matthews Township Parkway, Matthews, NC 28105 | 2007-04-11 |
| 1417086935 | Roy Joseph Friedman | Family Medicine | 1450 Matthews Township Parkway, Suite 450, Matthews, NC 28105-5343 | 2007-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750917407 | Lauren Deasy Blackshaw | Counselor | 1163 Sam Newell Rd, Matthews, NC 28105 | 2020-03-13 |
| 1912549643 | Monarch | Community/Behavioral Health | 10545 Paces Avenue 634, Matthews, NC 28105 | 2019-10-15 |
| 1326515768 | Holly Harvey Heddleson | Nurse Practitioner | 1450 Matthews Township Pkwy Ste 280, Matthews, NC 28105 | 2018-10-24 |
| 1396241030 | Erickson Health Medical Group of North Carolina, PC | Internal Medicine | 2030 Windsor Run Lane, Matthews, NC 28105 | 2018-04-02 |
| 1811406994 | Lice Clinics of America of The Carolinas | Technician, Other | 3042 Suite C Senna Dr, Matthews, NC 28105 | 2017-09-21 |
| 1376065003 | Carillon Assisted Living of Mint Hill, LLC | Custodial Care Facility | 5601 Margaret Wallace Road, Matthews, NC 28105 | 2017-07-14 |
| 1568906055 | London Young | Physical Therapy Assistant | 11100- 11189 Berkley Square Ln, Charlotte, NC 28105 | 2016-12-19 |
| 1003363128 | New Beginnings Community Counseling Center | Community/Behavioral Health | 5232 Maragaret Wallace Road, Matthews, NC 28105 | 2016-09-07 |
| 1275993149 | Kristi Dougan | Nurse Practitioner | 434 N Trade St Ste 104, Matthews, NC 28105 | 2016-03-04 |
| 1205219896 | Kalyani Vellanki Starr | Dentist | 1819 Matthews Township Pkwy Ste 200, Matthews, NC 28105 | 2015-07-01 |
| Find all providers in zip 28105 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| 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 |
|---|---|---|---|---|
| 1033723531 | Novant Medical Group, Inc. | Surgery | 1450 Matthews Township Pkwy Ste 320, Matthews, NC 28105-2389 | 2020-09-02 |
| 1699034603 | Anna Blair Johnson | Surgery | 1450 Matthews Township Pkwy Ste 355, Matthews, NC 28105-4300 | 2012-05-10 |
| 1043426158 | Iyore Amy-otabor James | Surgery | 1450 Matthews Township Pkwy Ste 250, Matthews, NC 28105-5331 | 2007-05-15 |
| 1508393927 | Novant Medical Group, Inc. | Surgery | 1450 Matthews Township Pkwy, Suite 320, Matthews, NC 28105-2387 | 2017-05-16 |
| 1932631850 | Novant Medical Group, Inc. | Surgery | 1450 Matthews Township Pkwy, Suite 355, Matthews, NC 28105-2387 | 2017-03-30 |
| 1275893927 | Natalie Nowak | Surgery | 1450 Matthews Township Pkwy Ste 250, Matthews, NC 28105-5331 | 2012-05-29 |
| 1336460922 | Jennifer Samples Holl | Surgery | 1450 Matthews Township Pkwy Ste 250, Matthews, NC 28105 | 2010-06-17 |
| 1255577367 | Novant Medical Group Inc | Surgery | 1450 Matthews Township Pkwy, Suite 110, Matthews, NC 28105-2388 | 2008-12-18 |
| 1205870516 | Jeffrey Andrew Bohn | Surgery | 1450 Matthews Township Pkwy, Suite360, Matthews, NC 28105-2387 | 2006-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639701980 | Orthopaedic Surgery Center of Panther Creek LLC | Surgery | 6715 Mccrimmon Pkwy Ste 100, Cary, NC 27519-1916 | 2020-02-05 |
| 1922645571 | Novant Medical Group, Inc. | Surgery | 6324 Fairview Rd Ste 420, Charlotte, NC 28210-3372 | 2019-12-03 |
| 1790335180 | Shihao Lao | Surgery | 2301 Erwin Rd # Dumc2837, Durham, NC 27705-4699 | 2019-09-17 |
| 1336795137 | Novant Medical Group, Inc. | Surgery | 3515 W Market St Ste 310, Greensboro, NC 27403-4438 | 2019-08-16 |
| 1548721046 | Aman Kumar | Surgery | Unc Hospitals Department of Surgery, 101 Manning Drive, Chapel Hill, NC 27514 | 2019-03-27 |
| 1164980546 | Moses Cone Physician Services, Inc. | Surgery | 1041 Kirkpatrick Rd Ste 150, Burlington, NC 27215-8068 | 2019-03-05 |
| 1154806271 | The Cosmetic Concierge, Pllc | Surgery | 325 Arlington Ave Unit B, Charlotte, NC 28203-4574 | 2018-09-25 |
| 1386128601 | Venkateswara Rao Gurram | Surgery | 5075 Winster Dr Apt 202, Winston Salem, NC 27106-2988 | 2018-09-21 |
| 1376022533 | Shawn Thomas Colwell | Surgery | 411 Dogwood Ln, Wilmington, NC 28409-5805 | 2018-08-08 |
| 1235646670 | Jasper Louis Phillips Jr. | Surgery | 2522 Dogwood Ln, Kinston, NC 28504-7102 | 2018-01-08 |
| Find all providers with the same taxonomy | ||||
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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.