Healthcare Provider Details

I. General information

NPI: 1902968886
Provider Name (Legal Business Name): WLADYSLAW BOBAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 THOMPSON DRIVE
DONORA PA
15033
US

IV. Provider business mailing address

129 SIMPSON ROAD SUITE 103
BROWNSVILLE PA
15417
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-8544
  • Fax: 724-379-5211
Mailing address:
  • Phone: 724-785-5540
  • Fax: 724-785-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD029824E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: