Individual
J ERIC WIECZOREK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
456 LOCUST STREET, SIDMAN, PA 15955
(814) 487-5721
(814) 487-4781
Mailing address
456 LOCUST STREET, PO BOX 199, SIDMAN, PA 15955
(814) 487-5721
(814) 487-4781
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD027159E
PA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
MD 027159E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010215060002
—
PA
Enumeration date
05/16/2006
Last updated
01/10/2011
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