Individual
CHRISTOPHER J WISGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3998 RED LION RD, PHILADELPHIA, PA 19114-1445
(215) 612-4963
(215) 612-4532
Mailing address
PO BOX 8500-6335, PHILADELPHIA, PA 19178-6335
(215) 612-4963
(215) 612-4532
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD057309L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001603467
—
PA
01
—
0016034670008
PROMISE
PA
01
—
0870310000
KEYSTONE
PA
01
—
30010341
KEYSTONE MERCY
PA
01
—
838274
BS
PA
Enumeration date
05/01/2006
Last updated
01/05/2015
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