Provider Demographics
NPI:1063431393
Name:CHWIECKO, PAUL JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEROME
Last Name:CHWIECKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:484-628-0799
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:950B N WYOMISSING BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1783
Practice Address - Country:US
Practice Address - Phone:484-628-2490
Practice Address - Fax:610-288-4515
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065926L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001708594Medicaid
PA014784Medicare PIN