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NPI Code Detail

MEDICARE: CHRISTINE C WALLISCH

MEDICARE: CHRISTINE C WALLISCH
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
11223G0001XGeneral Practice DentistryDS037504PA

General Provider Information

NPI Number : 1215162581
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE C WALLISCH
Provider Business Mailing Address
First Line : PO BOX 3189
Second Line :
City : SYRACUSE
State : NY
Zip : 13220-3189
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7372 MCKNIGHT RD STE B
Second Line :
City : PITTSBURGH
State : PA
Zip : 15237-3558
Country : US
Telephone Number : 412-364-6440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2009
Last Update Date : 05/15/2009

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Directions to “ CHRISTINE C WALLISCH ” Practice Location

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