Individual
ASHA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
167 CONVERSE RD, MARION, MA 02738-1720
(508) 748-9749
Mailing address
167 CONVERSE RD, MARION, MA 02738-1720
(508) 748-9749
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30997
MA
Other
Enumeration date
05/12/2009
Last updated
05/12/2009
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