Individual
RICHARD CHWASTIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
617 E BROAD ST, TAMAQUA, PA 18252-2206
(570) 668-5170
(570) 668-5171
Mailing address
617 E BROAD ST, TAMAQUA, PA 18252-2206
(570) 668-5170
(570) 668-5171
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC002158L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153345
HIGHMARK BLUE SHIELD
PA
Enumeration date
08/02/2005
Last updated
12/17/2007
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