Provider Demographics
NPI:1326331893
Name:FOLAD, WALLY (MD)
Entity Type:Individual
Prefix:
First Name:WALLY
Middle Name:
Last Name:FOLAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-7224
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:6166 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3912
Practice Address - Country:US
Practice Address - Phone:725-223-4100
Practice Address - Fax:865-560-7110
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50944207R00000X, 208M00000X
KY49722207R00000X
NV17389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012228Medicaid
TN6039779OtherBLUE CROSS/BLUE SHIELD
TNP01505983OtherRR MEDICARE
TN103I115425Medicare PIN