Provider Demographics
NPI:1245235118
Name:WYSZOMIERSKI, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:WYSZOMIERSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2278
Mailing Address - Country:US
Mailing Address - Phone:724-537-0591
Mailing Address - Fax:724-532-0610
Practice Address - Street 1:210 WELDON ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1848
Practice Address - Country:US
Practice Address - Phone:724-539-3535
Practice Address - Fax:724-532-0610
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030754E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101297OtherHIGHMARK
PA000972920003Medicaid
PA812894OtherAETNA HMO
PA102996OtherUPMC FOR YOU
PA4278510OtherAETNA MANAGED CHOICE
PA163796OtherTHREE RIVERS MEDPLUS
PAP000880OtherGATEWAY HEALTH PLAN
PA101297OtherHIGHMARK
PA101297T7LMedicare ID - Type Unspecified