Justin Robert Wallace
Vascular Surgeon
530 South St Suite 380
Greensburg
, Pennsylvania 15601-2775
Justin Robert Wallace
Vascular Surgeon
530 South St Suite 380
Greensburg
, Pennsylvania 15601-2775
(724) 522-4002
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About
Features
Specialties
- Vascular Surgeon
Languages spoken
- English
Location
First Address
- Justin Robert Wallace
- 520 Jefferson Ave Suite 400
- Jeannette, PA
- Zip : 15644-2538
- Fax : (724) 522-4002
- Phone : (724) 527-8060
Second Address
- Justin Robert Wallace
- 530 South St Suite 380
- Greensburg, PA
- Zip : 15601-2775
- Phone : (724) 261-5556
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0129X | Vascular Surgeon | MD443733 | PA |
National Provider Identifier
| NPI | 1033372594 |
|---|---|
| Provider Name | Justin Robert Wallace |
| First Address | Jeannette, PA 15644-2538 |
| Second Address | Greensburg, PA 15601-2775 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 05/07/2008 |
| Last Update Date | 07/01/2017 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 103020618 | (05) | PA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.