| Doctor Name: | DR. JUSTIN ROBERT WALLACE |
| NPI Number: | 1033372594 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD443733 |
| Business Practice Address: | 530 South St Suite 380 Greensburg, PA - 156012775 |
| Business Phone Number: | 7242615556 |
| Business Fax Number: | |
| Mailing Address: | 530 South St, Suite 380 GREENSBURG |
| State: | PA |
| Postal Code: | 156012775 |
| Phone Number: | 7242615556 |
| Fax Number: | |
| NPI Enumeration Date: | 07/05/2008 |
| NPI Last Update Date: | 05/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | MD443733 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |