Provider Demographics
NPI:1467630079
Name:WAHL & SON'S FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:WAHL & SON'S FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-452-7370
Mailing Address - Street 1:835 EDMUND ST
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:PA
Mailing Address - Zip Code:16037-9109
Mailing Address - Country:US
Mailing Address - Phone:724-452-7370
Mailing Address - Fax:724-452-8599
Practice Address - Street 1:835 EDMUND ST
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:PA
Practice Address - Zip Code:16037-9109
Practice Address - Country:US
Practice Address - Phone:724-452-7370
Practice Address - Fax:724-452-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040649L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1802291Medicaid
PA040580Medicare PIN