RYAN JEFFREY WALLACE PA-C NPI 1285528422

NPI Information

  • NPI: 1285528422
  • Provider Name: RYAN JEFFREY WALLACE, PA-C
  • Classification: Physician Assistant - 363AS0400X
  • Specialization: Surgical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 5401 PEACH ST STE 3300
    ERIE, PA
    ZIP 16509
  • Phone: (814) 868-7840

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NPI Details

Ryan Jeffrey Wallace, PA-C is a surgical physician assistant in Erie, PA with 1 years of experience. Ryan Jeffrey Wallace, PA-C NPI is 1285528422. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5401 PEACH ST STE 3300
ERIE, PA
ZIP 16509-601
Phone: (814) 868-7840

The NPI 1285528422 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/4/2025 and was last updated on 6/4/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AS0400XPhysician AssistantSurgical1226276PENNSYLVANIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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