| Mark R Wallace, MD | |
|
1400 E Kincaid St, Mount Vernon, WA 98274-4127 | |
| (360) 848-4150 | |
| (360) 428-6485 |
| Full Name | Mark R Wallace |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine - Infectious Disease |
| Location | 1400 E Kincaid St, Mount Vernon, Washington |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982683603 | NPI | - | NPPES |
| 275105400 | Medicaid | FL | |
| 2039554 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | MD00020591 (Washington) | Primary |
| 207RI0200X | Internal Medicine - Infectious Disease | ME94199 (Florida) | Secondary |
| Entity Name | Public Hospital Dist No 1 Skagit |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1023332749 PECOS PAC ID: 6800793522 Enrollment ID: O20040309001059 |
| Mailing Address | Practice Location Address |
|---|---|
| Mark R Wallace, MD 1400 E Kincaid St, Attn: Credentialing, Mount Vernon, WA 98274-4127 Ph: (360) 428-2500 | Mark R Wallace, MD 1400 E Kincaid St, Mount Vernon, WA 98274-4127 Ph: (360) 848-4150 |
Connie L. Davis, Infectious Disease Medicare: Not Enrolled in Medicare Practice Location: 208 Hospital Parkway, Mount Vernon, WA 98274 Phone: 360-428-8260 Fax: 360-428-8576 |
Ramy Lewez Hanna, M.D. Infectious Disease Medicare: Accepting Medicare Assignments Practice Location: 307 S. 13th Street, Suite 300, Mount Vernon, WA 98274 Phone: 360-336-9757 Fax: 360-814-5237 |
Dr. Samuel M. Donohoe, MD Infectious Disease Medicare: Accepting Medicare Assignments Practice Location: 1415 E Kincaid St, Hospitalists Office, Mount Vernon, WA 98274 Phone: 360-416-5750 Fax: 360-416-5758 |
Joshua David Larson, DO Infectious Disease Medicare: Accepting Medicare Assignments Practice Location: 1415 E Kincaid St, Mount Vernon, WA 98274 Phone: 360-814-2115 |
Luis Garduno, Infectious Disease Medicare: Accepting Medicare Assignments Practice Location: 110 N Laventure Rd Ste C, Mount Vernon, WA 98273 Phone: 360-814-8240 |
Sankar S Alagugurusamy, MD Infectious Disease Medicare: Accepting Medicare Assignments Practice Location: 1400 E Kincaid St, Mount Vernon, WA 98274 Phone: 360-814-6113 Fax: 360-814-6110 |
Chia-jen Kuan, M.D., PHD Infectious Disease Medicare: Accepting Medicare Assignments Practice Location: 1500 E Broadway, Mount Vernon, WA 98274 Phone: 425-257-1100 Fax: 251-286-2102 |