Active NPI
David Wallach
- Contractor
- Raleigh, NC
National Provider Identifier
1033595772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 54270
- Practice address
- 3100 Cone Manor LN
Raleigh, NC 27613-6607 - Phone
- (919) 272-8230
- NPI assigned
- Aug 5, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 54270 | NC | Primary |
Addresses
Primary practice location
3100 Cone Manor LN
Raleigh, NC 27613-6607
Mailing address
3100 Cone Manor LN
Raleigh, NC 27613-6607
Phone (919) 272-8230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54270 | NC | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438732800000",
"number": "1033595772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 CONE MANOR LN",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276136607",
"telephone_number": "919-272-8230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 CONE MANOR LN",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276136607",
"telephone_number": "919-272-8230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACH",
"first_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-05",
"last_updated": "2015-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "NC",
"license": "54270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.