Organization
WALLACE VASCULAR, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN ROBERT WALLACE MD (MEDICAL DOCTOR)
(724) 201-2399
Entity
Organization
Contact information
Practice address
51 DUTILH RD STE 100, CRANBERRY TOWNSHIP, PA 16066-4148
(724) 201-2399
(724) 776-3864
Mailing address
51 DUTILH RD STE 100, CRANBERRY TOWNSHIP, PA 16066-4148
(724) 201-2399
(724) 776-3864
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
08/22/2022
Last updated
08/22/2022
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