Healthcare Provider Details

I. General information

NPI: 1134199763
Provider Name (Legal Business Name): CONRAD WEISER MEDICAL GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 W PENN AVE
WOMELSDORF PA
19567-9770
US

IV. Provider business mailing address

1137 W PENN AVE
WOMELSDORF PA
19567-9770
US

V. Phone/Fax

Practice location:
  • Phone: 610-589-2555
  • Fax: 610-589-4940
Mailing address:
  • Phone: 610-589-2555
  • Fax: 610-589-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDWARD T. BIGOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-589-2555