Healthcare Provider Details

I. General information

NPI: 1265494637
Provider Name (Legal Business Name): CHEST DISEASES OF NORTHWESTERN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 PEACH ST STE 103
ERIE PA
16508-2776
US

IV. Provider business mailing address

3580 PEACH ST STE 103
ERIE PA
16508-2776
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-4755
  • Fax: 814-864-5430
Mailing address:
  • Phone: 814-864-4755
  • Fax: 814-864-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS A WITTMANN
Title or Position: PRESIDENT
Credential: MD
Phone: 814-864-4755