Provider Demographics
NPI:1346230844
Name:WILFONG, DONALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:WILFONG
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 1:105 HILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-1400
Mailing Address - Country:US
Mailing Address - Phone:724-274-8812
Mailing Address - Fax:724-274-5660
Practice Address - Street 1:105 HILL AVE
Practice Address - Street 2:
Practice Address - City:CHESWICK
Practice Address - State:PA
Practice Address - Zip Code:15024-1400
Practice Address - Country:US
Practice Address - Phone:724-274-8812
Practice Address - Fax:724-274-5660
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023862E207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008654930003Medicaid
PAC32939Medicare UPIN
PA0008654930003Medicaid
PAP00161978Medicare PIN
PA181175R7RMedicare PIN