Provider Demographics
NPI:1033110515
Name:WEGRZYNOWICZ, DENISE D (DO)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:D
Last Name:WEGRZYNOWICZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:R
Other - Last Name:DENNLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6521 STEUBENVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-1005
Mailing Address - Country:US
Mailing Address - Phone:412-749-6920
Mailing Address - Fax:412-749-6779
Practice Address - Street 1:6521 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1005
Practice Address - Country:US
Practice Address - Phone:412-749-6920
Practice Address - Fax:412-749-6779
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010074L207Q00000X
WV1812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001830590Medicaid
PA001830590Medicaid