Provider Demographics
NPI:1225693864
Name:WIEGMANN, AVA FAITH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AVA
Middle Name:FAITH
Last Name:WIEGMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AVA
Other - Middle Name:FAITH
Other - Last Name:SHAHDADIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2000 OXFORD DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1841
Mailing Address - Country:US
Mailing Address - Phone:412-831-7570
Mailing Address - Fax:412-267-6183
Practice Address - Street 1:2000 OXFORD DR STE 201
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1841
Practice Address - Country:US
Practice Address - Phone:412-831-7570
Practice Address - Fax:412-267-6183
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007252363AM0700X
MDC07252363A00000X
PAOA006827363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant