Individual
DR. DUSTIN MARK WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 KNOWLSON AVE, BEAVER FALLS, PA 15010-1634
(724) 891-2100
(724) 891-2735
Mailing address
100 KNOWLSON AVE, BEAVER FALLS, PA 15010-1634
(724) 891-2100
(724) 891-2735
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD438369
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024783480001
—
PA
Enumeration date
08/16/2009
Last updated
02/26/2024
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