Individual
WALLACE PHILIP SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BM BCH PHD
Contact information
Practice address
CLINICAL CENTER NIH, BETHESDA, MD 20892-0001
(202) 679-6003
Mailing address
1730 NEW HAMPSHIRE AVE NW APT 19, WASHINGTON, DC 20009-2545
(202) 679-6003
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
D-48403
MD
Other
Enumeration date
07/13/2020
Last updated
07/13/2020
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