Provider Demographics
NPI:1376508002
Name:WIEGAND, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WIEGAND
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 1:207 HOUSE AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-761-5556
Mailing Address - Fax:717-761-8166
Practice Address - Street 1:207 HOUSE AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011
Practice Address - Country:US
Practice Address - Phone:717-761-5556
Practice Address - Fax:717-761-8166
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029030E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01651501OtherCAPITAL BLUE CROSS
PAB40010OtherHEALTHAMERICA HEALTHASSUR
PAP00283265OtherPALMETTO GBA RAILROAD MED
PA1089665Medicaid
PA01651501OtherKEYSTONE HEALTH PLAN CENT
PA152808OtherHIGHMARK BLUE SHIELD
PA21199OtherGEISINGER HEALTH PLAN
PA152808OtherHIGHMARK BLUE SHIELD
B40010Medicare UPIN