Individual
MICHELLE D WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9701 APOLLO DR STE 105, LARGO, MD 20774-4785
(301) 985-2985
(240) 565-6034
Mailing address
9701 APOLLO DR STE 105, LARGO, MD 20774-4785
(301) 985-2985
(240) 565-6034
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10085097
CAREFIRST CHPDC
DC
01
—
10085097
MEDSTAR FAMILY CHOICE OF MD
MD
05
—
2021218766
—
VA
01
—
5906592
CIGNA
—
01
—
60402094
AMERI HEALTH CARITAS DC
DC
01
—
PDXGR13328727
AETNA BETTER HEALTH OF MARYLAND
MD
Enumeration date
03/15/2017
Last updated
10/21/2021
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