Healthcare Provider Details

I. General information

NPI: 1841283249
Provider Name (Legal Business Name): JANUSZ F WOLANIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S PROSPECT ST
NANTICOKE PA
18634-2443
US

IV. Provider business mailing address

233 S PROSPECT ST
NANTICOKE PA
18634-2443
US

V. Phone/Fax

Practice location:
  • Phone: 570-735-0102
  • Fax:
Mailing address:
  • Phone: 570-735-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD039316L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: