JACQUELINE M WALLACE PHYSICIAN NPI 1912945155

NPI Information

NPI: 1912945155
Provider Name: JACQUELINE M WALLACE, PHYSICIAN
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
10910 LITTLE PATUXENT PKWY
SUITE 100
COLUMBIA, MD
ZIP 21044
Phone: (410) 997-8444
Get Directions

Jacqueline M Wallace, PHYSICIAN is an obstetrics gynecology in Columbia, MD. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. Jacqueline M Wallace, PHYSICIAN NPI is 1912945155. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

10910 LITTLE PATUXENT PKWY
SUITE 100
COLUMBIA, MD
ZIP 21044-078
Phone: (410) 997-8444

The NPI 1912945155 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/2/2006 and was last updated on 6/22/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207V00000X	Obstetrics & Gynecology		MD059921L	PENNSYLVANIA	No
2	207V00000X	Obstetrics & Gynecology		D0069282	MARYLAND	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	H76750	MEDICARE UPIN
2	101044156	MEDICAID	PENNSYLVANIA
3	080787	MEDICARE ID-TYPE UNSPECIFIED

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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