MEDICARE: INTERNAL MEDICINE ASSOCIATES OF WYOMING VALLEY

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

General Provider Information

NPI Number	:	1629249107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOCIATES OF WYOMING VALLEY

Provider Business Mailing Address
First Line	:	8 CHURCH ST STE 216
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-3539
Country	:	US
Telephone Number	:	570-821-7391
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 CHURCH ST STE 216
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-3539
Country	:	US
Telephone Number	:	570-821-7391
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA A MERA
Credential	:	DO
Telephone Number	:	570-821-7391

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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