Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | MD026049E | PA |
NPI | 1306848148 |
---|---|
Provider Name | Donald Lawrence Wickerham |
First Address | Pittsburgh, PA 15212-4756 |
Second Address | Pittsburgh, PA 15212-4756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000864191 | (05) | PA |
3810008593 | (05) | WV |
B36848 | (02) | PA |