Provider Demographics
NPI:1184702110
Name:WALWORTH MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:WALWORTH MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DONOFRIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-837-4000
Mailing Address - Street 1:1275 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-837-4000
Mailing Address - Fax:724-837-4119
Practice Address - Street 1:1275 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-837-4000
Practice Address - Fax:724-837-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1774015OtherHIGHMARK
PA1774015OtherHIGHMARK