Provider Demographics
NPI:1043305337
Name:PETER A WIGGIN DPM INC
Entity Type:Organization
Organization Name:PETER A WIGGIN DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:WIGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-756-1875
Mailing Address - Street 1:74 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2211
Mailing Address - Country:US
Mailing Address - Phone:419-756-1875
Mailing Address - Fax:419-525-3264
Practice Address - Street 1:74 WOOD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2211
Practice Address - Country:US
Practice Address - Phone:419-756-1875
Practice Address - Fax:419-525-3264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2841321Medicaid
OH0634719Medicaid
OH9370181Medicare PIN
OH4975280001Medicare NSC
OH0634719Medicaid