Wallace, Richard Austin

Wallace, Richard Austin is an individual health care provider with primary practice located at 1306 Kanawha Blvd E , Charleston WV 25301-3001. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otology & Neurotology, which is considered as his primary health care specialty. Wallace, Richard Austin can be contacted via phone (304) 343-4371.

Contact Information

Primary practice address
1306 Kanawha Blvd E Charleston WV 25301-3001
Phone: (304) 343-4371
Fax: (304) 353-0215
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otology & Neurotology 207YX0901X WV11648 West Virginia

Profile Details

NPI number 1013957034
LBN Legal business name Wallace, Richard Austin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 7th, 2006
Last updated Dec 12th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013957034 NPPES
West Virginia Other 1013957034 NPI
West Virginia MEDICAID 010107500 NPI

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