Provider Demographics
NPI:1780681601
Name:YASWINSKI, PETER T JR (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:T
Last Name:YASWINSKI
Suffix:JR
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 1:206 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-421-6040
Mailing Address - Fax:570-421-5290
Practice Address - Street 1:369 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9101
Practice Address - Country:US
Practice Address - Phone:570-421-6040
Practice Address - Fax:570-421-5290
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028986E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009562840002Medicaid
PA0009562840004Medicaid
PA065640OtherBLUE SHIELD
PA0009562840002Medicaid
PA065640OtherBLUE SHIELD