Mary Margaret Wallach, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1746 Issued in SC

Practice address

905 Verdae Blvd Ste 103
Greenville, SC 29607-4029

Phone

(864) 522-2186

NPI assigned

May 7, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217
  Medicare reassignment NPD
• Prisma Health University Medical Group

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557273600000",
    "number": "1124517941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT STE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154536",
            "telephone_number": "864-797-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 VERDAE BLVD STE 103",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296074029",
            "telephone_number": "864-522-2186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACH",
        "first_name": "MARY",
        "middle_name": "MARGARET",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-07",
        "last_updated": "2019-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "SC",
            "license": "1746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglass Michael Wallace, MD
• James E. B. Wallace Jr.
• Lisa Wallace, CNP
• Monte N Wallace, LMSW
• Robert Raymond Wallace, DMD
• Carol F Wallen, R. PH
• Catherine Wallenborn, LISW-CP
• Lee Waller, PHARM.D.
• Thomasena Sarahdetta Waller, RN
• Blake Wallert, PT, DPT

• Registered Dietitian in Greenville, SC
• Providers in Greenville, SC by specialty
• Registered Dietitian in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.