Organization
PEDIATRIC ASSOCIATES OF LATROBE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A WYSZOMIERSKI MD (OWNER)
(724) 539-8380
Entity
Organization
Contact information
Practice address
210 WELDON ST, LATROBE, PA 15650-1848
(724) 539-8380
(724) 532-0610
Mailing address
210 WELDON ST, LATROBE, PA 15650-1848
(724) 539-8380
(724) 532-0610
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033384
HIGHMARK GROUP PROVIDER #
PA
01
—
042486
AETNA HMO GP PROVIDER #
PA
05
—
1001387
—
PA
05
—
1012372320001
—
PA
05
—
163793
—
PA
Enumeration date
05/16/2006
Last updated
06/23/2008
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