Dr Ryan Myles Wallace, | |
55 Lock St, New Haven, CT 06511 | |
(203) 432-0290 | |
Not Available |
Full Name | Dr Ryan Myles Wallace |
---|---|
Gender | Male |
Speciality | Psychiatry |
Experience | 10 Years |
Location | 55 Lock St, New Haven, Connecticut |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1548695075 | NPI | - | NPPES |
008056168 | Medicaid | CT | |
008076123 | Medicaid | CT | |
500000315 | Medicaid | CT | |
004082286 | Medicaid | CT | |
008022626 | Medicaid | CT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084N0400X | Psychiatry & Neurology - Neurology | 55490 (Connecticut) | Secondary |
2084P0800X | Psychiatry & Neurology - Psychiatry | 55490 (Connecticut) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
Providence Alaska Medical Center | Anchorage, AK | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Providence Health And Services- Washington | 1557408176 | 149 |
Providence Health And Services Washington | 2163335746 | 30 |
Entity Name | Providence Health & Services Washington |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1467547265 PECOS PAC ID: 2163335746 Enrollment ID: O20031110000525 |
Entity Name | Providence Health & Services- Washington |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1093956278 PECOS PAC ID: 1557408176 Enrollment ID: O20091029000679 |
Mailing Address | Practice Location Address |
---|---|
Dr Ryan Myles Wallace, 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 Ph: (203) 781-4600 | Dr Ryan Myles Wallace, 55 Lock St, New Haven, CT 06511 Ph: (203) 432-0290 |
Sharon Hasbani, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 136 Sherman Ave, New Haven, CT 06511 Phone: 203-562-8071 | |
Dr. Jennifer Buenzle Dwyer, M.D., PH.D. Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 20 York St # T-209, Yale-new Haven Hospital, New Haven, CT 06510 Phone: 203-433-2788 Fax: 203-688-5599 | |
Neeharika Thottempudi, MBBS Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 20 York St, New Haven, CT 06510 Phone: 203-688-4242 | |
Dr. Nancy Dian Olson, M.D. Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 47 Trumbull St, New Haven, CT 06510 Phone: 203-785-1898 Fax: 203-281-3707 | |
George J. Watstein, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 100 York St, Suite 2 A, New Haven, CT 06511 Phone: 203-624-6431 Fax: 203-624-6452 | |
Dr. Sidney Hornor Phillips, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 234 Church St, Suite #300, New Haven, CT 06510 Phone: 203-865-8246 | |
Dr. Marc D. Schwartz, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 26 Trumbull St, New Haven, CT 06511 Phone: 203-562-9873 Fax: 203-624-2422 |