Provider Demographics
NPI:1841283249
Name:WOLANIN, JANUSZ F (MD)
Entity type:Individual
Prefix:
First Name:JANUSZ
Middle Name:F
Last Name:WOLANIN
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 1:233 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-2443
Mailing Address - Country:US
Mailing Address - Phone:570-735-0102
Mailing Address - Fax:
Practice Address - Street 1:233 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-2443
Practice Address - Country:US
Practice Address - Phone:570-735-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039316L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099894OtherHIGHMARK BLUE SHIELD
PA20003003OtherTRAVELERS MEDICARE
PA0009556800001Medicaid
PA2449970000OtherINDEPENDENCE BLUE CROSS
PA002743OtherFIRST PRIORITY HEALTH
PA29746OtherGEISINGER HEALTH PLAN
PA29746OtherGEISINGER HEALTH PLAN