Physician Compare National (NPI:1356393672)

HEALTHCARE PROVIDER: J ERIC WIECZOREK MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1356393672
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810069580
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080714000007
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WIECZOREK
	Individual professional last name
Provider First Name	J
	Individual professional first name
Provider Middle Name	ERIC
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GERIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GERIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	456 LOCUST ST
	Group Practice or individual's line 1 address
City	SIDMAN
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	15955
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8144875721
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	390110
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CONEMAUGH MEMORIAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	390112
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	WINDBER HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	390039
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SOMERSET HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y