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NPI Code Detail

MEDICARE: DR. COREY J WALLACH MD

MEDICARE: DR. COREY J WALLACH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistMD425770PA
2207X00000XOrthopaedic Surgery PhysicianA95705CA
3207XS0117XOrthopaedic Surgery of the Spine PhysicianA95705CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417923863
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COREY J WALLACH MD
Provider Business Mailing Address
First Line : 2800 S SHIRLINGTON RD STE 1100
Second Line :
City : ARLINGTON
State : VA
Zip : 22206-3605
Country : US
Telephone Number : 703-892-6500
Fax Number : 703-892-1550
Provider Business Practice Location Address
First Line : 2800 S SHIRLINGTON RD STE 1100
Second Line :
City : ARLINGTON
State : VA
Zip : 22206-3605
Country : US
Telephone Number : 703-892-6500
Fax Number : 703-892-1550
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 02/01/2025

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Directions to “ DR. COREY J WALLACH MD” Practice Location

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