Provider Demographics
NPI:1831289628
Name:HERTWECK, MARK LAWRENCE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LAWRENCE
Last Name:HERTWECK
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:110 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-3052
Mailing Address - Country:US
Mailing Address - Phone:412-486-3337
Mailing Address - Fax:
Practice Address - Street 1:7180 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-1206
Practice Address - Country:US
Practice Address - Phone:412-365-5201
Practice Address - Fax:412-365-5225
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA 000329L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical