Individual
DR. RYAN LEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
185 PILGRIM RD, BOSTON, MA 02215-5324
(617) 667-8800
Mailing address
185 PILGRIM RD, BOSTON, MA 02215-5324
(617) 667-8800
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
1022399
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/01/2019
Last updated
05/01/2026
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