Provider Demographics
NPI:1245463934
Name:WALLACE, KAREN L (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:WALLACE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:330 MOUNT AUBURN ST
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:617-499-5070
Mailing Address - Fax:
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-499-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2405952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology