1568429033 NPI number — DAVID A WIEGAND MD PC

Table of content: (NPI 1568429033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568429033 NPI number — DAVID A WIEGAND MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID A WIEGAND MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568429033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 HOUSE AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
CAMP HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-761-5556
Provider Business Mailing Address Fax Number:
717-761-8166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 HOUSE AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
CAMP HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-761-5556
Provider Business Practice Location Address Fax Number:
717-761-8166
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIEGAND
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-761-5556

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B40010 . This is a "HEALTHASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DE2877 . This is a "PALMETTO GBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02608300 . This is a "KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1796749 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02608300 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: B40010 . This is a "HEALTHAMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02608300 . This is a "KEYSTONE SENIOR BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 645B . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DE2877 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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