Provider Demographics
NPI:1134199763
Name:CONRAD WEISER MEDICAL GROUP P.C.
Entity type:Organization
Organization Name:CONRAD WEISER MEDICAL GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:BIGOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-589-2555
Mailing Address - Street 1:1137 W PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-9770
Mailing Address - Country:US
Mailing Address - Phone:610-589-2555
Mailing Address - Fax:610-589-4940
Practice Address - Street 1:1137 W PENN AVE
Practice Address - Street 2:
Practice Address - City:WOMELSDORF
Practice Address - State:PA
Practice Address - Zip Code:19567-9770
Practice Address - Country:US
Practice Address - Phone:610-589-2555
Practice Address - Fax:610-589-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02548100OtherBLUE CROSS PROV #
PA0011394440002Medicaid
PACO119780OtherHIGHMARK PROVIDER #
PACO119780Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER