Active NPI
Darrell Y Wallace, LIC. AC.
- Acupuncturist
- Concord, MA
National Provider Identifier
1447496922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 203604
- Practice address
- The Concord Clinic
56 Winthrop Street
Concord, MA 01742 - Phone
- (617) 719-4592
- NPI assigned
- Jan 5, 2009
- Last updated
- Jan 5, 2009
- 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 203604 | MA | Primary |
Addresses
Primary practice location
The Concord Clinic
56 Winthrop Street
Concord, MA 01742
Mailing address
123 Belmont St
Belmont, MA 02478-3638
Phone (617) 719-4592
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 |
|---|---|---|---|
| 203604 | MA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231113600000",
"number": "1447496922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 BELMONT ST",
"city": "BELMONT",
"state": "MA",
"postal_code": "024783638",
"telephone_number": "617-719-4592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "THE CONCORD CLINIC",
"address_2": "56 WINTHROP STREET",
"city": "CONCORD",
"state": "MA",
"postal_code": "01742",
"telephone_number": "617-719-4592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DARRELL",
"middle_name": "Y",
"credential": "LIC. AC.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-01-05",
"last_updated": "2009-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "MA",
"license": "203604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.