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General NPI Number Information
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NPI Number | 1629106448
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Entity Type | Organization
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Legal Business Name | JAMES R WALL MD PC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2895 HAMILTON BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18104-6172
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Country | US
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Telephone | 610-432-8312
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Fax | 610-432-3366
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Provider Business Mailing Address
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Address Line | 2895 HAMILTON BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18104-6172
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Country | US
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Telephone | 610-432-8312
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Fax | 610-432-3366
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES R WALL
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Credential | MD
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Telephone | 610-432-8312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD015279E
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License Number State | PA
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