Provider Demographics
NPI:1417291923
Name:WISSER, MEREDITH LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:LYNN
Last Name:WISSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:L
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7000 STONEWOOD DR
Mailing Address - Street 2:SUITE 151
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7000 STONEWOOD DR STE 151
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7376
Practice Address - Country:US
Practice Address - Phone:724-933-0300
Practice Address - Fax:724-933-0456
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054962363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033676100001Medicaid