JUSTIN ROBERT WALLACE (NPI# 1033372594) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1033372594 |
Entity Type | Individual |
Full Name | JUSTIN ROBERT WALLACE |
Credential | MD |
Practice Address |
530 South St Suite 380 Greensburg PA 15601-2775 |
Mailing Address |
520 Jefferson Ave Suite 400 Jeannette PA 15644-2538 |
Practice Telephone | 7242615556 |
Mailing Telephone | 7245278060 |
Mailing Fax Number | 7245224002 |
Enumeration Date | 2008-07-05 |
Last Update Date | 2017-01-07 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
MD443733 | PA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
PA | 103020618 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417331679 | Justin Matthew Wallace | Marriage & Family Therapist | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2015-07-16 |
1649609728 | Justin K Wallace | Veterinarian | 120 S 6th St, Chickasha, OK 73018-3420 | 2013-11-08 |
1114354156 | Justin Cory Wallace | Military Health Care Provider | 699 14th St, San Diego, CA 92101-7586 | 2013-10-06 |
1578807103 | Justin Covey Wallace | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2012-11-20 |
Street Address |
530 SOUTH ST SUITE 380 |
City | GREENSBURG |
State | PA |
Zip Code | 15601-2775 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548267198 | Mark A. Zelkovic | Surgery | 530 South St, Suite 300, Greensburg, PA 15601-2775 | 2005-06-28 |
1578193991 | Excela Health Physician Practices, Inc | Surgery | 530 South St, Greensburg, PA 15601-2775 | 2020-01-24 |
1669880993 | Jerod Craig Smith | Nurse Practitioner | 530 South St, Suite 380, Greensburg, PA 15601-2775 | 2014-07-30 |
1598185506 | Robert Alexander Pearce | Internal Medicine | 530 South St, Greensburg, PA 15601-2775 | 2014-04-17 |
1285053835 | Kaleigh Adkins | Specialist/Technologist | 530 South St, Greensburg, PA 15601-2775 | 2014-04-10 |
1134562879 | Ashwin Krishnan Thiagarajasubramanian | Internal Medicine | 530 South St, Greensburg, PA 15601-2775 | 2013-04-11 |
1710288311 | Andrea N Altieri | Physician Assistant | 530 South St, Suite 300, Greensburg, PA 15601-2775 | 2010-11-12 |
1356662688 | Daniel Lee Meikle | Surgery | 530 South St, Suite G10, Greensburg, PA 15601-2775 | 2010-06-22 |
1386880227 | Rishi Kad | Internal Medicine | 530 South St, Second Floor, Greensburg, PA 15601-2775 | 2008-12-24 |
1093965329 | Elizabeth L. Detschelt | Radiology | 530 South St, Suite 380, Greensburg, PA 15601-2775 | 2008-09-23 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689274128 | Chelsea Anne Lyle | Counselor | Yaroch Counseling, 437 S Maple Ave, Greensburg, PA 15601 | 2020-10-26 |
1538649280 | Valor Healthcare Inc | Nurse Practitioner | 5274 Route 30 East, Suite 10, Greensburg, PA 15601 | 2018-08-21 |
1285121889 | Eugene Flenner Jr. | Orthotist | 3 Gibraltar Way, Greensburg, PA 15601 | 2018-04-18 |
1417461724 | Westmoreland County Area Agency On Aging | Case Management | 200 South Main St., Greensburg, PA 15601 | 2017-11-22 |
1225549769 | Beth Ann Marie Schmidle | Nurse Practitioner | 540 South Street - Medical Commons 2, Suite 302, Greensburg, PA 15601 | 2017-10-23 |
1386167138 | Connections Counseling of Western Pa | Community/Behavioral Health | 231 S Main Street, Suite 404, Greensburg, PA 15601 | 2017-07-24 |
1164963112 | Cory Kunicky | Counselor | 333 Harvey Avenue, Greensburgh, PA 15601 | 2017-03-10 |
1801348826 | Flow Spine & Sport LLC | Chiropractor | 123 Donohoe Drive, Greensburg, PA 15601 | 2016-10-25 |
1235583402 | Marc James Aukerman | Chiropractor | 424 Frye Farm Road, Greensburg, PA 15601 | 2016-04-14 |
1336502806 | Claire Campero | Counselor | One Northgate Square Ste 200, Greensburg, PA 15601 | 2016-04-01 |
Find all providers in zip 15601 |
Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144361932 | Surgical Associates, Ltd | Surgery | 433 Frye Farm Rd, Suite 10, Greensburg, PA 15601-6480 | 2007-02-12 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720630650 | Broad Street Professional Medical Services LLC | Surgery | 2033 S Broad St Ste A, Philadelphia, PA 19148-5505 | 2019-07-11 |
1124670922 | Broad Street Medical LLC | Surgery | 2033 S Broad St Ste B, Philadelphia, PA 19148-5505 | 2019-07-11 |
1932610755 | Vascular Surgical Specialists Pllc | Surgery | 1450 E Boot Rd Ste 600b, West Chester, PA 19380-5968 | 2017-10-19 |
1336515956 | Aria Health Physician Services | Surgery | 9501 Roosevelt Blvd Ste 312, Philadelphia, PA 19114-1028 | 2015-08-18 |
1437525490 | Advanced Vein and Laser Center Lancaster, LLC | Surgery | 896a Plaza Blvd, Lancaster, PA 17601-2745 | 2015-08-13 |
1447658877 | Center for Vein Restoration Pa Pllc | Surgery | 1338 Bristol Pike Ste 205, Bensalem, PA 19020-5679 | 2014-12-17 |
1023423167 | Catherine Go | Surgery | 420 S Aiken Ave, Apt A6, Pittsburgh, PA 15232-1226 | 2014-06-27 |
1659703635 | Walter J. Fagan | Surgery | 211 Center Ave, Jim Thorpe, PA 18229-1205 | 2013-08-01 |
1346521267 | Usa Vein Clinics of Philadelphia LLC | Surgery | 51 Cameron Rd, Huntingdon Valley, PA 19006-1401 | 2011-09-06 |
1124314893 | Nathan Loren Liang | Surgery | 200 Lothrop St # A-1017, Pittsburgh, PA 15213-2536 | 2011-06-21 |
Find all providers with the same taxonomy |
City | GREENSBURG |
Zip Code | 15601 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.