Provider Demographics
NPI:1669484259
Name:WOCH, GUSTAW (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAW
Middle Name:
Last Name:WOCH
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 1:6 HEARTHSTONE CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3065
Mailing Address - Country:US
Mailing Address - Phone:610-779-9550
Mailing Address - Fax:610-779-6433
Practice Address - Street 1:6 HEARTHSTONE CT
Practice Address - Street 2:SUITE 201
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3065
Practice Address - Country:US
Practice Address - Phone:610-779-9550
Practice Address - Fax:610-779-6433
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD429384208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101939422Medicaid
PA104328JPUMedicare PIN