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General NPI Number Information
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NPI Number | 1689674905
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Entity Type | Individual
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Provider Name | WILLIAM TODD WALLENS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3754 MILITARY RD
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City | NIAGARA FALLS
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State | NY
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Zip | 14305-3517
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Country | US
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Telephone | 716-298-4330
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Fax |
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Provider Business Mailing Address
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Address Line | 3754 MILITARY RD
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City | NIAGARA FALLS
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State | NY
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Zip | 14305-3517
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Country | US
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Telephone | 716-298-4330
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Fax |
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 116615
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License Number State | NY
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