Provider Demographics
NPI:1407898430
Name:WALLACE, RHONDA ALICE MCKENDREE (DO)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:ALICE MCKENDREE
Last Name:WALLACE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:12311 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8344
Mailing Address - Country:US
Mailing Address - Phone:878-332-4159
Mailing Address - Fax:878-332-4479
Practice Address - Street 1:12311 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8344
Practice Address - Country:US
Practice Address - Phone:878-332-4159
Practice Address - Fax:878-332-4479
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009889L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine