person
Max Lee Wallace JR., MD
Diagnostic Radiology Physician in New Britain, Connecticut
NPI 1588624282

Max Lee Wallace JR. is a Diagnostic Radiology Physician based in New Britain, CT and is specialized in Diagnostic Radiology. Max Lee Wallace JR. practices in New Britain, CT and has the professional credentials of MD. The NPI Number for Max Lee Wallace JR. is 1588624282 and holds a License No. 023301 (Connecticut).

The current practice location address for Max Lee Wallace JR. is 40 Hart St, New Britain, CT and can be reached out via phone at 860-229-2059 and via fax at 860-229-8495. You can also correspond with Max Lee Wallace JR. through the mailing address at 40 HART ST, NEW BRITAIN, CT - 06052-1743 (mailing address contact number: 860-229-2059).

Location: 40 Hart St, New Britain, CT, 06052-1743
person
Provider Profile Details
NPI Number
1588624282
Provider Name
Max Lee Wallace JR.
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
40 Hart St, New Britain, CT, 06052-1743
Phone Number
860-229-2059
Fax Number
860-229-8495
Provider Enumeration Date
03/25/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
300117749 01 CT RAILROAD MEDICARE
010023301CT13 01 CT ANTHEM BC/BS
001233014 05 CT
010026126CT12 01 CT ANTHEM BC/BS
010026126CT03 01 CT ANTHEM BC/BS
010026126CT14 01 CT ANTHEM BC/BS
1588624282 05 CT
010026126CT04 01 CT ANTHEM BC/BS
010026126CT07 01 CT ANTHEM BC/BS
300023202 01 CT RAILROAD MEDICARE
300106345 01 CT RAILROAD MEDICARE
institution
Provider Business Practice Location Address Details
Address
40 Hart St
City
State
Zip
06052-1743
Phone Number
860-229-2059
Fax Number
860-229-8495
person
Provider Business Mailing Address Details
Address
40 Hart St
City
State
Zip
06052-1743
Phone Number
860-229-2059
Fax Number
860-229-8495
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Diagnostic Radiology
Taxonomy
License No.
023301 (Connecticut)
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
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