Provider Demographics
NPI:1033128467
Name:WALLISON, JUNE A (MD)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:A
Last Name:WALLISON
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:800 SPRUCE ST FL 2
Practice Address - Street 2:CHOP CARE NETWORK AT PENNSYLVANIA HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-3191
Practice Address - Fax:215-829-7123
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-04-17
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Provider Licenses
StateLicense IDTaxonomies
PAOS009764L208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8643008Medicaid
PA001728167Medicaid
PA022563Medicare ID - Type Unspecified
PA001728167Medicaid