Individual
DAVID WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 HOSPITAL PLZ, STAMFORD, CT 06902-3602
(203) 276-1000
Mailing address
1 HOSPITAL PLZ, STAMFORD, CT 06902-3602
(203) 276-1000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4572
CT
Other
Enumeration date
06/04/2019
Last updated
09/28/2021
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