Individual
DONALD WIEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-2019
(570) 214-9585
(570) 214-9519
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA057830
PA
363AM0700X
Medical Physician Assistant
MA057830
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WI466658
MEDICARE
PA
Enumeration date
09/25/2015
Last updated
03/09/2016
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