Provider Demographics
NPI:1811998313
Name:SHELDON WIDLAN MD PC
Entity type:Organization
Organization Name:SHELDON WIDLAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-539-8517
Mailing Address - Street 1:1100 LIGONIER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1917
Mailing Address - Country:US
Mailing Address - Phone:724-539-8577
Mailing Address - Fax:412-241-4325
Practice Address - Street 1:1100 LIGONIER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1917
Practice Address - Country:US
Practice Address - Phone:724-539-8577
Practice Address - Fax:412-241-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019695E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA63633Medicaid
B34447Medicare UPIN
PA052662Medicare ID - Type Unspecified