Provider Demographics
NPI:1447540349
Name:WASIELEWSKI, MATTHEW DAVID (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:WASIELEWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2316
Mailing Address - Country:US
Mailing Address - Phone:814-877-5800
Mailing Address - Fax:814-877-5809
Practice Address - Street 1:4500 PINE AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2316
Practice Address - Country:US
Practice Address - Phone:814-877-5800
Practice Address - Fax:814-877-5809
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine