MARK R. WALLACE (NPI# 1982683603) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982683603 |
| Entity Type | Individual |
| Full Name | MARK R. WALLACE |
| Credential | MD |
| Practice Address |
1400 E Kincaid St Mount Vernon WA 98274-4127 |
| Mailing Address |
1400 E Kincaid St Attn: Credentialing Mount Vernon WA 98274-4127 |
| Practice Telephone | 3608484150 |
| Practice Fax Number | 3604286485 |
| Mailing Telephone | 3604282500 |
| Mailing Fax Number | 3604286485 |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2017-02-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
MD00020591 | WA | Allopathic & Osteopathic Physicians |
| N | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
ME94199 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 2039554 | 05 | |
| FL | 275105400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538533005 | Mark Thomas Wallace | Speech-Language Pathologist | 2337 N 2nd St, Harrisburg, PA 17110-1009 | 2015-11-21 |
| 1942241096 | Mark Alan Wallace | Chiropractor | 2140 W Poplar Ave, Suite 107, Collierville, TN 38017-0624 | 2006-06-09 |
| 1669467213 | Mark Spangler Wallace | Dentist | 168 N 1950 W Ste 202, Salt Lake City, UT 84116-3007 | 2005-09-20 |
| 1932104205 | Mark Randall Wallace | Internal Medicine | 13400 E Shea Blvd, Scottsdale, AZ 85259 | 2005-06-14 |
| 1760753008 | Mark Edward Wallace | Psychiatry & Neurology | 77 7th Ave, #19d, New York, NY 10011-6645 | 2012-01-18 |
| 1205110434 | Mark James Wallace | Pharmacist | 301 S Sante Fe Ave, Edmond, OK 73003 | 2011-10-06 |
| 1932367539 | Mark Richard Wallace | Chiropractor | 9337 W 75th St, Overland Park, KS 66204 | 2008-05-30 |
| 1316119548 | Mark Steven Wallace | Hearing Instrument Specialist | 202 Grand Ave, Spencer, IA 51301 | 2008-03-27 |
| 1952591828 | Mark Allen Wallace | Otolaryngology | 333 Magazine St, Suite 101, Sault Sainte Marie, MI 49783-1867 | 2007-07-27 |
| 1104047190 | Mark C Wallace | Dentist | 50 County Road B E, Saint Paul, MN 55117-1927 | 2007-05-01 |
| Street Address |
1400 E KINCAID ST |
| City | MOUNT VERNON |
| State | WA |
| Zip Code | 98274-4127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972508836 | James William Hartley | Nurse Practitioner | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2005-06-16 |
| 1750997433 | Katie Akane Kaestner | Physician Assistant | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2020-09-18 |
| 1376189555 | Shaneen Fernandez | Advanced Practice Midwife | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2019-11-21 |
| 1558906008 | Andrea Marie Phillips | Advanced Practice Midwife | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2019-11-07 |
| 1174097026 | Rebecca Anne Knight | Advanced Practice Midwife | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2019-01-14 |
| 1700359445 | Michael A Payne | Registered Nurse | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2019-01-05 |
| 1093298051 | Emily Jean Jette | Physician Assistant | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2018-09-14 |
| 1841647849 | Marla Oakes | Pharmacist | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2016-05-19 |
| 1508213794 | Catherine Schnabel | Physician Assistant | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2016-05-18 |
| 1649634437 | Carlyn King | Obstetrics & Gynecology | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2016-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881123438 | Ankur Tarun Sanghvi | Peer Specialist | 209 Milwaukee Steet, 209, Mount Vernon, WA 98274 | 2017-06-07 |
| 1932647187 | Claudia Diaz | Counselor | 23550 Garden St, Mount Vernon, WA 98274 | 2017-02-08 |
| 1871042002 | Richard Simcock Dds, Ps | Dentist | 130 S 15th St Suite 101, Mount Vernon, WA 98274 | 2016-09-29 |
| 1528228186 | Parampreet Singh Ghuman | Internal Medicine | 121 S. 12th St, Ste B, Mount Vernon, WA 98274 | 2008-06-16 |
| 1699940874 | Eugene Villanueva De Guzman | Internal Medicine | 208 S Hospital Pkwy, Mount Vernon, WA 98274 | 2008-04-28 |
| 1871775122 | Matthew John Novak | Internal Medicine | 208 Hospital Pkwy, Mount Vernon, WA 98274 | 2007-11-28 |
| 1568658797 | Emily A K Bianconi | Nurse Practitioner | 2101 Little Mountain Lane, Mount Vernon, WA 98274 | 2007-09-21 |
| 1659576981 | Peggy Randall | Counselor | 1420 S 12th, Mount Vernon, WA 98274 | 2007-06-18 |
| 1194937037 | Cascade Neurologic Clinic, Inc, P.s. | Clinic/Center | 1315 East Division St., Mt. Vernon, WA 98274 | 2007-05-04 |
| 1427171297 | Keri L D Halgren | Dentist | 1711 E Division Street, Mt Vernon, WA 98274 | 2007-04-09 |
| Find all providers in zip 98274 | ||||
| Taxonomy Code | 207RI0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Infectious Disease |
| An internist who deals with infectious diseases of all types and in all organ systems. Conditions requiring selective use of antibiotics call for this special skill. This physician often diagnoses and treats AIDS patients and patients with fevers which have not been explained. Infectious disease specialists may also have expertise in preventive medicine and travel medicine. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285044917 | Collin T Dela Houssaye | Internal Medicine | 1400 E Kincaid St, Mount Vernon, WA 98274 | 2014-05-02 |
| 1295975779 | Madonna A. Biritwum | Internal Medicine | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2009-02-24 |
| 1508837329 | Mary Frances Bavaro | Internal Medicine | 1400 E Kincaid St, Mount Vernon, WA 98274-4127 | 2006-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417509746 | In Kwon Park Md Pllc | Internal Medicine | 11216 Sunrise Blvd E Ste 3-103, Puyallup, WA 98374-8848 | 2019-07-16 |
| 1982146072 | Barbara Kirby | Internal Medicine | 11111 Wachusett Rd, Woodway, WA 98020-6143 | 2016-11-07 |
| 1679961130 | Everett Infectious Diseases, Pllc | Internal Medicine | 717 Nw 190th Ln, Shoreline, WA 98177-3055 | 2015-01-06 |
| 1467726893 | Lynn Frumkin | Internal Medicine | 2543 1/2 56th Ave Sw, Seattle, WA 98116-2219 | 2012-03-02 |
| 1700181435 | Edward Lawrence Weber | Internal Medicine | 4109 Boulevard Place, Mercer Island, WA 98040-3403 | 2011-01-11 |
| 1437452034 | Neron Balassanian | Internal Medicine | 10650 Ne 9th Pl Unit 2322, Bellevue, WA 98004-5080 | 2010-12-21 |
| 1366764284 | Patrick O'malley Tennican | Internal Medicine | 665 N. Riverpoint Blvd., Suite 410, Spokane, WA 99202-1665 | 2010-02-19 |
| 1982854352 | Diego Lopez De Castilla | Internal Medicine | 12303 Ne 130th Ln Ste Coral120, Kirkland, WA 98034 | 2008-09-23 |
| 1982852554 | Reena K. Gulati | Internal Medicine | 701 5th Avenue, Seattle, WA 98104 | 2008-09-08 |
| 1215198254 | Jason W Van Winkle | Internal Medicine | 12303 Ne 130th Ln Ste 120, Kirkland, WA 98034 | 2008-06-23 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT VERNON |
| Zip Code | 98274 |
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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.