Organization
WYOMING VALLEY INFECTIOUS DISEASE ASSOC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY R DECKER MD (OWNER)
(570) 822-6036
Entity
Organization
Contact information
Practice address
545 N RIVER ST, SUITE 205, WILKES BARRE, PA 18702-2600
(570) 822-6036
(570) 829-1520
Mailing address
545 N RIVER ST, SUITE 205, WILKES BARRE, PA 18702-2600
(570) 822-6036
(570) 829-1520
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017767900002
—
PA
01
—
010284600
BLACK LUNG
PA
01
—
5507
GEISINGER HEALTH PLAN
PA
01
—
756235
HIGHMARK BLUE SHIELD
PA
01
—
809669
FIRST PRIORITY
PA
Enumeration date
05/12/2006
Last updated
11/19/2010
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