Provider Demographics
NPI:1558541409
Name:J. WALLACE MCMEEL, M.D., P.C.
Entity Type:Organization
Organization Name:J. WALLACE MCMEEL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF CLINICAL&BUSINESS OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITTEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-632-7776
Mailing Address - Street 1:1 AUTUMN ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5301
Mailing Address - Country:US
Mailing Address - Phone:617-632-7777
Mailing Address - Fax:617-632-7770
Practice Address - Street 1:1 AUTUMN ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5301
Practice Address - Country:US
Practice Address - Phone:617-632-7777
Practice Address - Fax:617-632-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA706773OtherTUFTS
MA15499OtherHARVARD PILGRIM
MAM13120OtherBCBS MA
MA2085445Medicaid
MA706773OtherTUFTS
MAM13120OtherBCBS MA