Provider Demographics
NPI:1922038546
Name:WILLIHNGANZ, WALTER DIEHL (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:DIEHL
Last Name:WILLIHNGANZ
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 1:401 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1264
Mailing Address - Country:US
Mailing Address - Phone:215-538-2011
Mailing Address - Fax:215-538-7580
Practice Address - Street 1:401 W BROAD ST
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1264
Practice Address - Country:US
Practice Address - Phone:215-538-2011
Practice Address - Fax:215-538-7580
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016784E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00074256400013Medicaid
PA156149Medicare ID - Type Unspecified
PAB40142Medicare UPIN