Provider Demographics
NPI:1326037482
Name:WIEGER, LAWRENCE A (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:WIEGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-2935
Mailing Address - Fax:717-544-3935
Practice Address - Street 1:2150 HARRISBURG PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-2935
Practice Address - Fax:717-544-3935
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006930L207Q00000X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001167636Medicaid
F02395Medicare UPIN
PA001167636Medicaid