Provider Demographics
NPI:1629063854
Name:MCGREW, WALLACE R (MD)
Entity type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:R
Last Name:MCGREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:330 23RD AVE N STE 300
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1690
Mailing Address - Country:US
Mailing Address - Phone:615-342-5900
Mailing Address - Fax:615-342-6084
Practice Address - Street 1:330 23RD AVE N STE 300
Practice Address - Street 2:SUITE 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1690
Practice Address - Country:US
Practice Address - Phone:615-342-5900
Practice Address - Fax:615-342-6084
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD13612207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3199910Medicaid
KY6477311200Medicaid
TN100015681OtherRAILROAD MEDICARE
TN3199912Medicare PIN
TN100015681OtherRAILROAD MEDICARE