Provider Demographics
NPI:1619917002
Name:WISER, ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:WISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4070 BUTLER PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1556
Mailing Address - Country:US
Mailing Address - Phone:610-825-5741
Mailing Address - Fax:610-825-1855
Practice Address - Street 1:4070 BUTLER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1556
Practice Address - Country:US
Practice Address - Phone:610-825-5741
Practice Address - Fax:610-825-1855
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD019617E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0047237000OtherIBC - PC/KHPE
PA104841OtherHIGHMARK BLUE SHIELD
PA36452-MD019617EOtherHEALTH PARTNERS
PA0047237000OtherAMERIHEALTH/INTERCOUNTY
PA080128475OtherRRM
PA1193395OtherCIGNA HMO/PPO
PA11046883OtherMULTIPLAN
PA4101143OtherAETNA PPO
PAP518644OtherOXFORD
PA0075840102OtherAMERIHEALTH (UHC MA PLAN)
PA2124766OtherALLIANCE/OPT CHC (MAMSI)
PA0002469OtherAETNA HMO
PA1027898OtherKEYSTONE MERCY
PA10938918OtherCAQH ID#
PA0007584010001Medicaid
PA350984OtherPHCS
PA36452-MD019617EOtherHEALTH PARTNERS
PA0075840102OtherAMERIHEALTH (UHC MA PLAN)