Healthcare Provider Details

I. General information

NPI: 1962840348
Provider Name (Legal Business Name): STEVEN D WESS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 HOWARD AVE STE B204
ALTOONA PA
16601-4811
US

IV. Provider business mailing address

501 HOWARD AVE STE B204
ALTOONA PA
16601-4811
US

V. Phone/Fax

Practice location:
  • Phone: 814-201-2835
  • Fax: 814-201-2886
Mailing address:
  • Phone: 814-201-2835
  • Fax: 814-201-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056831
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: