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General NPI Number Information
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NPI Number | 1114929403
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Entity Type | Individual
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Provider Name | WALLACE C GAUNTNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 824 CALIFORNIA AVE
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City | PITTSBURGH
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State | PA
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Zip | 15202-2706
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Country | US
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Telephone | 412-766-3232
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Fax | 412-766-4320
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Provider Business Mailing Address
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Address Line | 824 CALIFORNIA AVE
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City | PITTSBURGH
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State | PA
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Zip | 15202-2706
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Country | US
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Telephone | 412-766-3232
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Fax | 412-766-4320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 35068280
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD019281E
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License Number State | PA
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