Robert Steven Wallis, M.D.

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

49370 Issued in CT

Practice address

55 Saunders Hollow Rd
Old Lyme, CT 06371-1127

Phone

(860) 598-9160

NPI assigned

May 11, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1154555738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 SAUNDERS HOLLOW RD",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063711127",
            "telephone_number": "860-598-9160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 SAUNDERS HOLLOW RD",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063711127",
            "telephone_number": "860-598-9160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "ROBERT",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-11",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "DC",
            "license": "MD037184",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NJ",
            "license": "25MA07059900",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CT",
            "license": "49370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Troncale
• Lisa Umanita, LCSW
• Hannah M S C Urgo, PA-C
• Amber Gabriella Vernacatola
• Walgreen Co
• Wassef LLC
• Wassef LLC
• Amy Beth Weldon-Beardslee, NP
• Laura Lee Wessell, LMT
• Ashley Wilson, MS CCC-SLP

• Infectious Disease Physician in Old Lyme, CT
• Providers in Old Lyme, CT by specialty
• Infectious Disease Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.