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NPI Code Detail

MEDICARE: MARISA N WALLAS DO

MEDICARE: MARISA N WALLAS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianOS022818PA

General Provider Information

NPI Number : 1033748199
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISA N WALLAS DO
Provider Business Mailing Address
First Line : 600 GRANT ST FL 58
Second Line :
City : PITTSBURGH
State : PA
Zip : 15219-2739
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20630 ROUTE 19
Second Line :
City : CRANBERRY TOWNSHIP
State : PA
Zip : 16066-6021
Country : US
Telephone Number : 724-779-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2020
Last Update Date : 09/07/2023

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Directions to “ MARISA N WALLAS DO” Practice Location

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