Provider Demographics
NPI:1457376527
Name:WELLS, WALLACE HARRY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:HARRY
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:303 W 19TH ST
Mailing Address - Street 2:SUITE 51
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3939
Mailing Address - Country:US
Mailing Address - Phone:212-813-3146
Mailing Address - Fax:212-813-3146
Practice Address - Street 1:303 W 19TH ST
Practice Address - Street 2:SUITE 51
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3939
Practice Address - Country:US
Practice Address - Phone:212-813-3146
Practice Address - Fax:212-813-3146
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY160840207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease