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Contact Information

RICHARD A WALLACE, MD
1306 KANAWHA BLVD E
CHARLESTON, WV25301-3001
 Phone: 304-343-4371
 Fax: 304-353-0215
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otology & Neurotology

207YX0901X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for RICHARD A WALLACE · (Male)

NPI # 1013957034
Status Active
Credentials MD
Entity Individual
Enumeration date 06/07/2006
Last updated 12/12/2012 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • WV License # WV11648
  • WV Medicaid 010107500
  • WV Other 1013957034 NPI
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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