Derrick I Wallace, MD is a medicare enrolled "Otolaryngology" physician in Nutley, New Jersey. His current practice location is
187 Washington Ave, Suite 2i, Nutley, New Jersey. You can reach out to his office (for appointments etc.) via phone at
(973) 235-0090.
Derrick I Wallace is licensed to practice in New Jersey (license number 25MA08175200) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1114900362.
Physician's Profile
| Full Name | Derrick I Wallace |
|---|
| Gender | Male |
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| Speciality | |
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| Experience | Years |
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| Location | 187 Washington Ave, Nutley, New Jersey |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Derrick I Wallace attended and graduated from in
NPI Data:
- NPI Number: 1114900362
- Provider Enumeration Date: 11/22/2005
- Last Update Date: 11/29/2011
Medicare PECOS Information:
- PECOS PAC ID:
- Enrollment ID:
Medical Identifiers
Medical identifiers for Derrick I Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1114900362 | NPI | - | NPPES |
| 02237176 | Medicaid | NY | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Y00000X | Otolaryngology | 208988 (New York) | Secondary |
| 207Y00000X | Otolaryngology | 25MA08175200 (New Jersey) | 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. Derrick I 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 |
|---|
Derrick I Wallace, MD
187 Washinton Ave, Suite 2i,
Nutley, NJ 07110-1980
Ph: (973) 235-0090 | Derrick I Wallace, MD
187 Washington Ave, Suite 2i,
Nutley, NJ 07110-3935
Ph: (973) 235-0090 |
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