Provider Demographics
NPI:1568429033
Name:DAVID A WIEGAND MD PC
Entity Type:Organization
Organization Name:DAVID A WIEGAND MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIEGAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-761-5556
Mailing Address - Street 1:207 HOUSE AVE
Mailing Address - Street 2:STE 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 AVE
Practice Address - Street 2:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40010OtherHEALTHASSURANCE
PADE2877OtherPALMETTO GBA
PA02608300OtherKEYSTONE HEALTH PLAN
PA1796749OtherHIGHMARK BLUE SHIELD
PA02608300OtherCAPITAL BLUE CROSS
PAB40010OtherHEALTHAMERICA
PA02608300OtherKEYSTONE SENIOR BLUE
PA645BOtherGEISINGER HEALTH PLAN
PADE2877OtherRAILROAD MEDICARE
PA02608300OtherKEYSTONE HEALTH PLAN
PA02608300OtherCAPITAL BLUE CROSS