MEDICARE: DR. DONALD J. WILFONG MD

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	207R00000X	Internal Medicine Physician	MD023862E	PA

General Provider Information

NPI Number	:	1346230844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD J. WILFONG MD

Provider Business Mailing Address
First Line	:	105 HILL AVE
Second Line	:
City	:	CHESWICK
State	:	PA
Zip	:	15024-1400
Country	:	US
Telephone Number	:	724-274-8812
Fax Number	:	724-274-5660

Provider Business Practice Location Address
First Line	:	105 HILL AVE
Second Line	:
City	:	CHESWICK
State	:	PA
Zip	:	15024-1400
Country	:	US
Telephone Number	:	724-274-8812
Fax Number	:	724-274-5660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	10/09/2020

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