Individual
IRA B WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 BALA PLAZA, 333 E CITY AVENUE, BALA CYNWYD, PA 19004-1501
(610) 668-2777
(610) 668-1509
Mailing address
2 BALA PLAZA, 333 E CITY AVENUE, BALA CYNWYD, PA 19004-1501
(610) 668-2777
(610) 668-1509
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD032125E
PA
207W00000X
Ophthalmology Physician
Primary
MD032125E
PA
Other
Enumeration date
05/25/2006
Last updated
11/23/2010
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