Wallace Vascular, LLC.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

WALLACE VASCULAR, LLC.

Practice address

51 Dutilh Rd Ste 100
Cranberry Township, PA 16066-4148

Phone

(724) 201-2399

Fax

(724) 776-3864

NPI assigned

Aug 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin Robert Wallace, MD

Title

Medical Doctor

Phone

(724) 201-2399

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1629796941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 DUTILH RD STE 100",
            "city": "CRANBERRY TOWNSHIP",
            "state": "PA",
            "postal_code": "160664148",
            "telephone_number": "724-201-2399",
            "fax_number": "724-776-3864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 DUTILH RD STE 100",
            "city": "CRANBERRY TOWNSHIP",
            "state": "PA",
            "postal_code": "160664148",
            "telephone_number": "724-201-2399",
            "fax_number": "724-776-3864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE VASCULAR, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "724-201-2399",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhett Wahler
• Wendy Wahlquist, LMFT
• Wal-Mart Stores East LP
• Walgreen Co
• Ryan Walkovich, PHARMD
• Justin Robert Wallace, MD
• Marisa N Wallas, DO
• Chloe Warham, DPT
• Stephanie Nicole Waxler, B.ED.
• Collin Scott Weinblum, DNP

• Vascular Surgery Physician in Cranberry Township, PA
• Providers in Cranberry Township, PA by specialty
• Vascular Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.