Wallace, Justin Robert

Wallace, Justin Robert is an individual health care provider with primary practice located at 51 Dutilh Rd Ste 100 , Cranberry Township PA 16066-4148. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular Surgery, which is considered as his primary health care specialty. Wallace, Justin Robert can be contacted via phone (724) 278-3484.

Contact Information

Primary practice address
51 Dutilh Rd Ste 100 Cranberry Township PA 16066-4148
Phone: (724) 278-3484
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X MD443733 Pennsylvania

Profile Details

NPI number 1033372594
LBN Legal business name Wallace, Justin Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2008
Last updated Feb 9th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033372594 NPPES
Pennsylvania MEDICAID 103020618

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