MEDICARE: WYOMING VALLEY INFECTIOUS DISEASE ASSOC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	756235	OTHER	PA	HIGHMARK BLUE SHIELD
2	809669	OTHER	PA	FIRST PRIORITY
3	010284600	OTHER	PA	BLACK LUNG
4	5507	OTHER	PA	GEISINGER HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	756235	OTHER	PA	FIRST PRIORITY LIFE

General Provider Information

NPI Number	:	1154372373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYOMING VALLEY INFECTIOUS DISEASE ASSOC, PC

Provider Business Mailing Address
First Line	:	545 N RIVER ST
Second Line	:	SUITE 205
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2600
Country	:	US
Telephone Number	:	570-822-6036
Fax Number	:	570-829-1520

Provider Business Practice Location Address
First Line	:	545 N RIVER ST
Second Line	:	SUITE 205
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2600
Country	:	US
Telephone Number	:	570-822-6036
Fax Number	:	570-829-1520

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARY R DECKER
Credential	:	MD
Telephone Number	:	570-822-6036

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	11/19/2010

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Directions to “WYOMING VALLEY INFECTIOUS DISEASE ASSOC, PC ” Practice Location

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