Active NPI
Candace Wallace, CPT
- Phlebotomy Technician
- Baltimore, MD
National Provider Identifier
1790562510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebotomy Technician
- Practice address
- 6340 Security Blvd Ste 100
Baltimore, MD 21207-5284 - Phone
- (443) 272-1423
- Fax
- (443) 658-0623
- NPI assigned
- Sep 14, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Phlebotomy Technician | 246RP1900X | MD | Primary |
Addresses
Primary practice location
6340 Security Blvd Ste 100
Baltimore, MD 21207-5284
Mailing address
6340 Security Blvd Ste 100
Baltimore, MD 21207-5284
Phone (443) 272-1423
Other practice location 1
3952 Whispering Meadow Dr
Randallstown, MD 21133
Phone (443) 272-1423
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703894400000",
"number": "1790562510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6340 SECURITY BLVD STE 100",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212075284",
"telephone_number": "443-272-1423",
"fax_number": "443-658-0623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6340 SECURITY BLVD STE 100",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212075284",
"telephone_number": "443-272-1423",
"fax_number": "443-658-0623"
}
],
"practiceLocations": [
{
"address_1": "3952 Whispering Meadow Dr",
"address_purpose": "LOCATION",
"city": "Randallstown",
"state": "MD",
"postal_code": "21133",
"country_code": "US",
"telephone_number": "443-272-1423",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "CANDACE",
"name_prefix": "Ms.",
"credential": "CPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-14",
"last_updated": "2023-12-30",
"certification_date": "2023-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "246RP1900X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Phlebotomy",
"state": "MD",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.