Provider Demographics
NPI:1245292309
Name:WAKSTEIN, ANDREW M (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:WAKSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:217 FRANKLIN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1509
Mailing Address - Country:US
Mailing Address - Phone:610-824-5050
Mailing Address - Fax:610-824-5053
Practice Address - Street 1:217 FRANKLIN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1509
Practice Address - Country:US
Practice Address - Phone:610-824-5050
Practice Address - Fax:610-824-5053
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008560L207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3Y1476OtherHEALTHNET
PA818551OtherBLUE CARE/FIRST PRIORITY
PA9601794OtherGHI
PA596729OtherBLUE SHIELD
PA3184601OtherCAPITAL BLUE CROSS
PA0015442860004Medicaid
PA134975OtherMEDPLUS/UNISON
PA73747OtherGEISINGER
PAP00008002OtherMEDICARE RAILROAD
PA73747OtherGEISINGER
PAP00008002OtherMEDICARE RAILROAD