Individual
MICHAEL WALLACH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 CATAMORE BLVD, EAST PROVIDENCE, RI 02914
(401) 432-2520
Mailing address
20 CATAMORE BLVD, EAST PROVIDENCE, RI 02914
(401) 432-2520
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
7329
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000001988
NHPRI
—
01
—
004389
BLUE CHIP
—
01
—
007329
TUFTS
—
01
—
1600203
UNITED HEALTH PLANS
—
01
—
240161
RIH PILGRIM
—
01
—
3207765
HEALTHY START
—
01
—
7000630
RI MEDICAL ASSISTANCE
—
01
—
7329
FEP BLUE CROSS
—
01
—
W&I PILGRIM
240161
—
Enumeration date
01/31/2006
Last updated
07/08/2007
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