Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | MD459141 | PA |
N | 208200000X | Surgeon | MT206442 | PA |
N | 208600000X | Surgeon | MT206442 | PA |
NPI | 1962813949 |
---|---|
Provider Name | Dr. Sean Joseph Wallace |
First Address | Allentown, PA 18103-5622 |
Second Address | Allentown, PA 18103-6268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 06/08/2021 |