Dr Mark Allen Wallace, DO is a medicare enrolled "Otolaryngology - Plastic Surgery Within The Head & Neck" physician in Rockport, Maine. His current practice location is
15 Anchor Dr Ste 102, Rockport, Maine. You can reach out to his office (for appointments etc.) via phone at
(207) 301-3660.
Dr Mark Allen Wallace is licensed to practice in Maine (license number DO3910) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1952591828.
Physician's Profile
| Full Name | Dr Mark Allen Wallace |
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| Gender | Male |
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| Speciality | Otolaryngology - Plastic Surgery Within The Head & Neck |
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| Location | 15 Anchor Dr Ste 102, Rockport, Maine |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1952591828
- Provider Enumeration Date: 07/27/2007
- Last Update Date: 09/03/2025
Medicare PECOS Information:
- PECOS PAC ID: 4385724004
- Enrollment ID: I20190814000245
Medical Identifiers
Medical identifiers for Dr Mark Allen Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1952591828 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207YX0905X | Otolaryngology - Otolaryngology/facial Plastic Surgery | 5101015234 (Michigan) | Secondary |
| 207Y00000X | Otolaryngology | DO3910 (Maine) | Secondary |
| 207YX0007X | Otolaryngology - Plastic Surgery Within The Head & Neck | DO3910 (Maine) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Mark Allen Wallace allows following entities to bill medicare on his behalf.
| Entity Name | Commonwealth Healthcare Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1285858290
PECOS PAC ID: 7719075167
Enrollment ID: O20071212000093 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Mark Allen Wallace is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Mark Allen Wallace, DO
15 Anchor Dr Ste 102,
Rockport, ME 04856-3847
Ph: (207) 301-3660 | Dr Mark Allen Wallace, DO
15 Anchor Dr Ste 102,
Rockport, ME 04856-3847
Ph: (207) 301-3660 |
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