Individual
DR. HUGH J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1010 BETHESDA CT, WINSTON SALEM, NC 27103-3019
(336) 277-8800
(336) 277-8850
Mailing address
PO BOX 75216, CHARLOTTE, NC 28275-0216
(336) 718-7080
(336) 718-9622
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
9701639
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006005403
—
VA
01
—
10714
BLUE CROSS BLUE SHIELD
NC
01
—
20464
PARTNERS
—
01
—
3131142
AETNA HMO
—
01
—
3603374
UNITED HEALTHCARE
—
01
—
4652218
AETNA PPO
—
01
—
74692
MEDCOST
—
05
—
8910714
—
NC
Enumeration date
01/23/2006
Last updated
03/30/2011
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