Individual
KOJO WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
CENTRA LYNCHBURG GENERAL HOSPITAL, 1901 TATE SPRINGS RD, LYNCHBURG, VA 24501
(434) 200-3000
Mailing address
909 STATION WAY, HUNTINGTON STATION, NY 11746-1971
Taxonomy
Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
0101285554
VA
Other
Enumeration date
04/15/2015
Last updated
07/11/2025
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