Provider Demographics
NPI:1154334431
Name:WALLNER, ROBERT J (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WALLNER
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Gender:M
Credentials:DO
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Mailing Address - Street 1:101 GREENWOOD AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2627
Mailing Address - Country:US
Mailing Address - Phone:215-663-5910
Mailing Address - Fax:215-379-8458
Practice Address - Street 1:700 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6835
Practice Address - Country:US
Practice Address - Phone:215-663-5910
Practice Address - Fax:215-379-8458
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAOS002166L2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging