Healthcare Provider Details

I. General information

NPI: 1255627469
Provider Name (Legal Business Name): COLLEEN MICHELLE WALLACE MCKAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COLLEEN WALLACE M.D.

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0002
US

IV. Provider business mailing address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0002
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax:
Mailing address:
  • Phone: 504-284-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD500003331
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116023955
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD78050
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD78050
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: