Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Gonzalo A Wallis, MD

Individual provider Pediatrics Physician · NPI 1417179078

Gonzalo A Wallis, MD is a Pediatric Medicine in Charlotte, North Carolina. Qualified in 2001, 25 years ago. Practices with Carolinas Physicians Network Inc, a 2,328-clinician group, works from 5 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
25
Licensed in
NC
In the registry since
2007
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1001 Blythe Blvd Ste 500
Charlotte, NC 28203-5866
Phone: (704) 373-1813
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (4)

  • 100 Medical Park Dr, Concord, NC 28025-2948 — (704) 403-2860
  • 1781 Tate Blvd Se, Hickory, NC 28602-4251 — (704) 381-3970
  • 1550 Faulk St, Monroe, NC 28112-5086 — (704) 667-3410
  • 134 Medical Park Rd, Mooresville, NC 28117-8526 — (704) 801-9100

Specialties & licences

Pediatric Cardiology Physician (primary) Taxonomy 2080P0202X · Licence 2013-02269 (NC)
Pediatrics Physician Taxonomy 208000000X · Licence 2013-02269 (NC)

Record details

NPI number1417179078
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 3, 2007
Last updated in NPPESJuly 15, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPEDIATRIC MEDICINE
Medical schoolOTHER
Graduated 2001 (25 years in practice)
Group practice Carolinas Physicians Network Inc — 2328 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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