Individual
DR. BRIAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9005 KILBRIDE RD, BALTIMORE, MD 21236-2017
(443) 904-6999
Mailing address
9005 KILBRIDE RD, BALTIMORE, MD 21236-2017
(443) 904-6999
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
D31136
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372141800
—
MD
Enumeration date
03/10/2006
Last updated
02/28/2013
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