Provider Demographics
NPI:1770727000
Name:WOLESLAGLE, MATTHEW RYAN (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:WOLESLAGLE
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 1:100 EXCELA HEALTH DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9001
Mailing Address - Country:US
Mailing Address - Phone:724-804-1725
Mailing Address - Fax:724-804-1727
Practice Address - Street 1:100 EXCELA HEALTH DR STE 201
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9001
Practice Address - Country:US
Practice Address - Phone:724-804-1725
Practice Address - Fax:724-804-1727
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102749422Medicaid
PA102749422Medicaid