Individual
JOAN C WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 KEYSTONE AVE, SUITE 406, DREXEL HILL, PA 19026-1129
(610) 622-8900
(610) 622-8904
Mailing address
412 WYLDHAVEN RD, BRYN MAWR, PA 19010-1243
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MD015407E
PA
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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