MEDICARE: DR. DAVID A WYSZOMIERSKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD030754E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101297	OTHER	PA	HIGHMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	812894	OTHER	PA	AETNA HMO
4	102996	OTHER	PA	UPMC FOR YOU
5	4278510	OTHER	PA	AETNA MANAGED CHOICE
6	163796	OTHER	PA	THREE RIVERS MEDPLUS
7	P000880	OTHER	PA	GATEWAY HEALTH PLAN

General Provider Information

NPI Number	:	1245235118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A WYSZOMIERSKI M.D.

Provider Business Mailing Address
First Line	:	214 REBECCA DR
Second Line	:
City	:	LATROBE
State	:	PA
Zip	:	15650-2278
Country	:	US
Telephone Number	:	724-537-0591
Fax Number	:	724-532-0610

Provider Business Practice Location Address
First Line	:	210 WELDON ST
Second Line	:
City	:	LATROBE
State	:	PA
Zip	:	15650-1848
Country	:	US
Telephone Number	:	724-539-3535
Fax Number	:	724-532-0610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. DAVID A WYSZOMIERSKI M.D.” Practice Location

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