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

Mr. Jerrol B Wallace, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1316084932

Mr. Jerrol B Wallace, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Baltimore, Maryland. Graduated from Duke University School of Medicine in 2014, 12 years ago. Practices with Androscoggin Valley Hospital Inc, a 64-clinician group and accepts Medicare assignment. Licensed in Maryland and Virginia.

Years since qualifying
12
Trained at
Duke University School of Medicine
Licensed in
MD, VA
In the registry since
2007
Specialties on file
2
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

4940 Eastern Ave
Baltimore, MD 21224-2735
Phone: (410) 550-0100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence R246272 (MD)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 0024167758 (VA)

Record details

NPI number1316084932
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedJanuary 31, 2007
Last updated in NPPESFebruary 16, 2021
Certification dateFebruary 16, 2021

Medicare enrollment

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

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolDUKE UNIVERSITY SCHOOL OF MEDICINE
Graduated 2014 (12 years in practice)
Group practice Androscoggin Valley Hospital Inc — 64 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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