Individual
DR. PAUL MICHAEL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
528 N MAIN ST, PROVIDENCE, RI 02904
(401) 528-0123
(401) 528-0124
Mailing address
528 N MAIN ST UNIT 4, PROVIDENCE, RI 02904-5770
(401) 528-0123
(401) 528-0124
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD19363
RI
Other
Enumeration date
03/18/2019
Last updated
12/18/2025
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