Provider Demographics
NPI:1306999842
Name:WIELECHOWSKI, DAVID MASON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MASON
Last Name:WIELECHOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 GLENSHAW AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-2447
Mailing Address - Country:US
Mailing Address - Phone:724-444-8484
Mailing Address - Fax:724-444-8408
Practice Address - Street 1:503 GLENSHAW AVE
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-2447
Practice Address - Country:US
Practice Address - Phone:724-444-8484
Practice Address - Fax:724-444-8408
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-0358731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA582Medicare PIN