Provider Demographics
NPI:1730188491
Name:OSHELL, WALLACE DOUGLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:DOUGLAS
Last Name:OSHELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4501
Mailing Address - Country:US
Mailing Address - Phone:412-443-5445
Mailing Address - Fax:412-856-1328
Practice Address - Street 1:865 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4501
Practice Address - Country:US
Practice Address - Phone:412-824-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 003170 L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112041Medicare ID - Type Unspecified