Provider Demographics
NPI:1912439142
Name:WALLNER, ALEXANDER L (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:L
Last Name:WALLNER
Suffix:
Gender:M
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:WRIGHT FAMILY MEDICAL PAVILION
Mailing Address - Street 2:1330 COSHOCTON AVE
Mailing Address - City:MT. VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-397-5400
Mailing Address - Fax:740-399-3706
Practice Address - Street 1:1330 COSHOCTON AVE KNOX COMMUNITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-397-5400
Practice Address - Fax:740-399-3706
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH35.137352208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program