Healthcare Provider Details

I. General information

NPI: 1144856634
Provider Name (Legal Business Name): COLLIN PATRICK WURST PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 ARDMORE BLVD STE 100
PITTSBURGH PA
15221-4860
US

IV. Provider business mailing address

3824 NORTHERN PIKE STE 700
MONROEVILLE PA
15146-2184
US

V. Phone/Fax

Practice location:
  • Phone: 412-825-0500
  • Fax: 412-825-0720
Mailing address:
  • Phone: 412-457-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA061571
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: