Mr Cedric Charles Wallace, PA-C in Freeport, NY

Mr Cedric Charles Wallace, PA-C is a medicare enrolled "Physician Assistant" in Freeport, New York. His current practice location is 20 Coolidge Pl, Freeport, New York. You can reach out to his office (for appointments etc.) via phone at (516) 779-5996.

Mr Cedric Charles Wallace is licensed to practice in New York (license number 012591) 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 1891946240.

Contact Information

	Mr Cedric Charles Wallace, PA-C
	20 Coolidge Pl, Freeport, NY 11520-2543
	(516) 779-5996
	Not Available

Map and Direction

Provider's Profile

Full Name	Mr Cedric Charles Wallace
Gender	Male
Speciality	Physician Assistant
Location	20 Coolidge Pl, Freeport, New York
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1891946240
Provider Enumeration Date: 10/03/2008
Last Update Date: 04/02/2021

Medicare PECOS Information:

PECOS PAC ID: 3577750322
Enrollment ID: I20101207000244

Medical Identifiers

Medical identifiers for Mr Cedric Charles Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1891946240	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363A00000X	Physician Assistant	012591 (New York)	Primary

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. Mr Cedric Charles 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
Mr Cedric Charles Wallace, PA-C 20 Coolidge Pl, Freeport, NY 11520-2543 Ph: (516) 779-5996	Mr Cedric Charles Wallace, PA-C 20 Coolidge Pl, Freeport, NY 11520-2543 Ph: (516) 779-5996

Reviews and Comments

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Mr Cedric Charles Wallace, PA-C - Medicare Physician Assistant in Freeport, NY