Jacqueline M Wallace, PHYSICIAN

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

D0069282 Issued in MD

Practice address

10910 Little Patuxent Pkwy
Suite 100
Columbia, MD 21044-3078

Phone

(410) 997-8444

NPI assigned

Jun 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Baltimore Medical System, Inc.

  • Federally Qualified Health Center (FQHC)
  • Baltimore, MD
  • NPI 1164138152
  Medicare reassignment
• Lancaster Hma Physician Management, LLC

  • Family Medicine Physician
  • Lancaster, PA
  • NPI 1932272341

  Obstetrics & Gynecology

  NPD (past)

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277164800000",
    "number": "1912945155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10910 LITTLE PATUXENT PKWY",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443078",
            "telephone_number": "410-997-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10910 LITTLE PATUXENT PKWY",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443078",
            "telephone_number": "410-997-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JACQUELINE",
        "middle_name": "M",
        "credential": "PHYSICIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2010-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MD059921L",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MD",
            "license": "D0069282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101044156",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morgan Michele Walker, CNM
• Mychal Walker
• Rachael Deina Walker
• Sunni Alicia Walker
• Antoine Wallace
• Jonelle Wallace, APRN, NP-C
• Kaelah Simone Wallace
• Seanquile Wallace
• Paula Anissa Waller, LCSW-C
• Janeen Wallop

• Obstetrics & Gynecology Physician in Columbia, MD
• Providers in Columbia, MD by specialty
• Obstetrics & Gynecology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; 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.