Provider Demographics
NPI:1013905173
Name:SZEREMETA, WASYL (MD MBA)
Entity type:Individual
Prefix:DR
First Name:WASYL
Middle Name:
Last Name:SZEREMETA
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 W MARTIN ST # MS 49-2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-0903
Mailing Address - Country:US
Mailing Address - Phone:201-358-5909
Mailing Address - Fax:210-358-5940
Practice Address - Street 1:16723 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2351
Practice Address - Country:US
Practice Address - Phone:210-644-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258074207Y00000X, 207YP0228X
TXR5658207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1603609Medicaid
893014GBTMedicare ID - Type Unspecified
G38956Medicare UPIN