Provider Demographics
NPI:1174687099
Name:WALLINGTON, CHARLYCE J (MD)
Entity type:Individual
Prefix:
First Name:CHARLYCE
Middle Name:J
Last Name:WALLINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HERITAGE DR STE 820
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-9220
Mailing Address - Country:US
Mailing Address - Phone:610-326-8660
Mailing Address - Fax:610-326-8408
Practice Address - Street 1:800 HERITAGE DR STE 820
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-9220
Practice Address - Country:US
Practice Address - Phone:610-326-8660
Practice Address - Fax:610-326-8408
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-071392208000000X
PA468779208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics