Individual
DR. MARK WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
42 LAUREL RD E, SUITE # 3610, STRATFORD, NJ 08084-1354
(856) 482-9000
(856) 482-1159
Mailing address
PO BOX 635, BELLMAWR, NJ 08099-0635
(856) 770-5772
(856) 482-1159
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
MA03512400
NJ
2084P0800X
Psychiatry Physician
Primary
MA03512400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7596707
—
NJ
Enumeration date
02/13/2006
Last updated
11/18/2008
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