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General NPI Number Information
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NPI Number | 1457351892
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Entity Type | Individual
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Provider Name | PAUL J WIECKOWSKI DPM
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 PIKE ST
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City | WEIRTON
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State | WV
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Zip | 26062-3919
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Country | US
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Telephone | 304-723-1797
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Fax | 304-723-1755
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Provider Business Mailing Address
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Address Line | 101 PIKE ST
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City | WEIRTON
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State | WV
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Zip | 26062-3919
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Country | US
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Telephone | 304-723-1797
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Fax | 304-723-1755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC003459L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 259
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36003334W
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License Number State | OH
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