Provider Demographics
NPI:1265494637
Name:CHEST DISEASES OF NORTHWESTERN PA
Entity Type:Organization
Organization Name:CHEST DISEASES OF NORTHWESTERN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:WITTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-864-4755
Mailing Address - Street 1:3580 PEACH ST
Mailing Address - Street 2:STE 103
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2776
Mailing Address - Country:US
Mailing Address - Phone:814-864-4755
Mailing Address - Fax:814-864-5430
Practice Address - Street 1:3580 PEACH ST
Practice Address - Street 2:STE 103
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2776
Practice Address - Country:US
Practice Address - Phone:814-864-4755
Practice Address - Fax:814-864-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008738600003Medicaid
PA128218FR6Medicare PIN