Individual
CHARLES W WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4455 DRESSLER RD NW, CANTON, OH 44718-2785
(330) 497-6555
(330) 497-3281
Mailing address
4455 DRESSLER RD NW, CANTON, OH 44718-2785
(330) 497-6555
(330) 497-3281
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
330155
LA
207Q00000X
Family Medicine Physician
Primary
35080468W
OH
207Q00000X
Family Medicine Physician
70831
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000189519
THREE RIVERS HEALTH PLANS
—
01
—
000000490965
ANTHEM BCBS
—
01
—
1074
SUMMACARE HEALTH PLAN
—
05
—
2374014
—
OH
01
—
733074
BUCKEYE COMMUNITY HEALTH
—
01
—
Q016786D
HOMETOWN
—
Enumeration date
03/08/2006
Last updated
01/14/2025
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