Provider Demographics
NPI:1902808009
Name:BAERWALD, WOLFGANG HANS (MD)
Entity Type:Individual
Prefix:DR
First Name:WOLFGANG
Middle Name:HANS
Last Name:BAERWALD
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 1:15 ALLIANCE ST
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:17959-1101
Mailing Address - Country:US
Mailing Address - Phone:570-277-6218
Mailing Address - Fax:570-277-6398
Practice Address - Street 1:15 ALLIANCE ST
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:17959-1101
Practice Address - Country:US
Practice Address - Phone:570-277-6218
Practice Address - Fax:570-277-6398
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038695E174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01179619Medicaid
PA598613JT3Medicare PIN
PAB71490Medicare UPIN
PA151969ZDNKMedicare PIN