Provider Demographics
NPI:1508905886
Name:WAHL, AMY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:WAHL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8266 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-4444
Mailing Address - Country:US
Mailing Address - Phone:412-364-6429
Mailing Address - Fax:
Practice Address - Street 1:536 BROADWAY
Practice Address - Street 2:
Practice Address - City:PITCAIRN
Practice Address - State:PA
Practice Address - Zip Code:15140-1451
Practice Address - Country:US
Practice Address - Phone:412-372-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003308-L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU08282Medicare UPIN