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MICHAEL ANTHONY WALLACE IDC
NPI 1427216837
Military Health Care Provider - Independent Duty Corpsman in Portsmouth, VA

Active since June 02, 2008
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708(757) 953-6505 Get Directions Write a Review

NPPES record last updated: June 23, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Michael Anthony Wallace Idc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICHAEL ANTHONY WALLACE IDC (NPI 1427216837) is an individual independent duty corpsman provider in Portsmouth, Virginia and active in the NPI registry since June 2008.

NPPES Registry Identity

NPI1427216837
Entity TypeIndividualMale
Primary Taxonomy1710I1002X
Provider Legal NameMICHAEL ANTHONY WALLACECredential: IDC
Location Address620 JOHN PAUL JONES CIRPortsmouth, VA 23708-2111
Mailing Address620 John Paul Jones CirPortsmouth, VA 23708-2111 · (757) 953-6505
Phone(757) 953-6505
Sole ProprietorNo
Enumeration DateJune 2, 2008
Last NPPES UpdateJune 23, 2011
✔ NPI 1427216837 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers
Taxonomy Code1710I1002X
Definition
A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
620 JOHN PAUL JONES CIR, Portsmouth, VA 23708
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MEREDITH TVERDOSI CRNA
Nurse Anesthetist, Certified Registered
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708
Portsmouth City (757) 953-3238
ERIC FRANCIS SULAVA
Emergency Medicine
620 JOHN PAUL JONES CIR, NAVAL MEDICAL CENTER PORTSMOUTH
PORTSMOUTH, VA 23708
Portsmouth City (757) 953-0669
MRS. TIFFNY KUPER RHH
Dental Hygienist
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708
Portsmouth City (757) 953-2711
DR. LAKEISHA GOODE PHARMD
Pharmacist
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708
Portsmouth City (757) 953-7462
JASMINE WOOD MD
Surgery
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708
Portsmouth City (757) 953-1895
NICHOLAS FANSELOW
General Practice
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708
Portsmouth City (757) 953-0669
DR. DAVID JESSEN MD
Military Health Care Provider
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708
Portsmouth City (757) 953-2518
MRS. WILLAR MAE BAUM L.C.S.W.
Social Worker (Clinical)
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708
Portsmouth City (757) 953-9767

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Wallace's NPI number?

The NPI number for Michael Wallace is 1427216837. It was assigned to this individual provider in the NPPES registry on June 2, 2008.

Where is Michael Wallace located?

Michael Wallace practices at 620 John Paul Jones Cir, Portsmouth, VA 23708. The listed phone number is (757) 953-6505.

What is Michael Wallace's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

When was this NPI record last updated?

The NPPES record for Michael Wallace was last updated on June 23, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.