MEDICARE: DR. DAVID MICHAEL WALLACE SR. M.D.

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
1	207Q00000X	Family Medicine Physician	043144	GA
2	207Q00000X	Family Medicine Physician	0101269450	VA

General Provider Information

NPI Number	:	1134285810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MICHAEL WALLACE SR. M.D.

Provider Business Mailing Address
First Line	:	200 EATON ST
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23669-4000
Country	:	US
Telephone Number	:	757-726-5000
Fax Number	:	757-726-5001

Provider Business Practice Location Address
First Line	:	200 EATON ST
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23669-4000
Country	:	US
Telephone Number	:	757-726-5000
Fax Number	:	757-726-5001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	09/18/2020

Similar Medicare Providers

1689711046 — LUXOTTICA OF AMERICA INC
Practice Location Address:

4000 LUXOTTICA PL , ATTN MEDICARE DEPT
MASON, OH
45040-8114

Practice Phone: 513-765-3534
Practice Fax:

1205389764 — LUXOTTICA RETAIL NORTH AMERICA INC
Practice Location Address:

4000 LUXOTTICA PL , ATTN: MEDICARE DEPT
MASON, OH
45040-8114

Practice Phone: 513-765-6000
Practice Fax:

1538603709 — LUXOTTICA RETAIL NORTH AMERICA INC.
Practice Location Address:

4000 LUXOTTICA PL , ATTN: MEDICARE DEPARTMENT
MASON, OH
45040-8114

Practice Phone: 513-765-6623
Practice Fax:

1689648164 — DR. ANTHONY PHILIP FISHER MD
Practice Location Address:

200 EATON ST
HAMPTON, VA
23669-4000

Practice Phone: 757-726-5000
Practice Fax: 757-726-5001

1558336867 — DR. TODD A WEISMAN MD
Practice Location Address:

200 EATON ST
HAMPTON, VA
23669-4000

Practice Phone: 757-726-5000
Practice Fax: 757-510-9022

1326165929 — SENTARA MEDICAL GROUP
Practice Location Address:

200 EATON ST
HAMPTON, VA
23669-4000

Practice Phone: 757-726-5000
Practice Fax: 757-726-5001

Directions to “ DR. DAVID MICHAEL WALLACE SR. M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.