| Doctor Name: | ROBERT J WALLNER |
| NPI Number: | 1154334431 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | OS002166L |
| Business Practice Address: | 700 E Broad St Hazleton, PA - 182016835 |
| Business Phone Number: | 2156635910 |
| Business Fax Number: | 2153798458 |
| Mailing Address: | 101 Greenwood Ave, Suite 150 JENKINTOWN |
| State: | PA |
| Postal Code: | 190462627 |
| Phone Number: | 2156635910 |
| Fax Number: | 2153798458 |
| NPI Enumeration Date: | 08/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471M1202X |
| License Number: | OS002166L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Magnetic Resonance Imaging |
| Taxonomy Definition: | |