Organization
BC WALL MEDICAL GROUP PA
Active
Organization
BC WALL MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN K WALL M. D. (PRESIDENT)
(704) 866-4607
Entity
Organization
Contact information
Practice address
1574 UNION ROAD, A, GASTONIA, NC 28054-5633
(704) 866-4607
(704) 866-5292
Mailing address
557 CAMERON POINTE LN, BELMONT, NC 28012-6702
(704) 825-2363
(704) 825-2363
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9701190
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891057P
—
NC
Enumeration date
10/10/2007
Last updated
10/10/2007
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