Provider Demographics
NPI:1255361697
Name:WACHTEL, STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:WACHTEL
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:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-0336
Mailing Address - Country:US
Mailing Address - Phone:814-444-8910
Mailing Address - Fax:814-444-9782
Practice Address - Street 1:500 W BERKELEY ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5514
Practice Address - Country:US
Practice Address - Phone:724-430-5159
Practice Address - Fax:724-430-3382
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 057323-L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0401455000OtherINDEPENDENCE BLUE CROSS
PA0016088570002Medicaid
PA0401455000OtherPERSONAL CHOICE
PAWA674812OtherBLUE SHIELD
PA0401455000OtherPERSONAL CHOICE
PA220032417Medicare PIN
PA674812P38Medicare PIN