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General NPI Number Information
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NPI Number | 1376657635
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Entity Type | Organization
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Legal Business Name | WESTERN PENNSYLVANIA FAMILY MEDICINE ASSOCIATES, LTD.
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 2057 HARRISON AVE
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City | JEANNETTE
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State | PA
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Zip | 15644-1168
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Country | US
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Telephone | 724-527-5001
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Fax | 724-527-0990
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Provider Business Mailing Address
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Address Line | 2057 HARRISON AVE
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City | JEANNETTE
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State | PA
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Zip | 15644-1168
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Country | US
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Telephone | 724-527-5001
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Fax | 724-527-0990
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN MICHAEL WONG
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Credential | MD
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Telephone | 724-527-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD038763L
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License Number State | PA
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