Individual
JUSTIN ROBERT WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51 DUTILH RD STE 100, CRANBERRY TOWNSHIP, PA 16066-4148
(724) 278-3484
Mailing address
238 S. PENNSYLVANIA AVE. #775, GREENSBURG, PA 15601-3661
(724) 278-3484
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
MD443733
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103020618
—
PA
Enumeration date
07/05/2008
Last updated
02/09/2023
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