Provider Demographics
NPI:1073019519
Name:WIEMER, NICHOLAS DYLAN (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DYLAN
Last Name:WIEMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 QUINN DR STE 210
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275-1055
Mailing Address - Country:US
Mailing Address - Phone:412-294-1277
Mailing Address - Fax:412-294-1273
Practice Address - Street 1:200 QUINN DR STE 210
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275-1055
Practice Address - Country:US
Practice Address - Phone:412-294-1277
Practice Address - Fax:412-294-1273
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS023035207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology