Individual
MARY JEAN WALL
Active
Individual
MARY JEAN WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35059303W
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000339383
ANTHEM
OH
05
—
0783022
—
OH
05
—
1018989380001
—
PA
05
—
1018989380002
—
PA
05
—
1018989380003
—
PA
05
—
3810008142
—
WV
01
—
P00286495
RAILROAD MC
OH
Enumeration date
02/09/2006
Last updated
11/19/2007
Update your record
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