Individual
DANIEL JAY WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 IRVING ST NW, WASHINGTON, DC 20010-3017
(202) 877-7000
Mailing address
110 IRVING ST NW, WASHINGTON, DC 20010-3017
(202) 877-7000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD046458
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101264875
VIRGINIA
VA
01
—
MD046458
DISTRICT OF COLUMBIA
DC
Enumeration date
01/30/2015
Last updated
01/09/2019
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