John Gerald Wandalowski

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD014228E Issued in PA

Practice address

200 Old Post Road
Clarks Summit, PA 18411-1083

Phone

(570) 587-1306

NPI assigned

Oct 21, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224547200000",
    "number": "1770735979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OLD POST ROAD",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184111083",
            "telephone_number": "570-587-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 OLD POST ROAD",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184111083",
            "telephone_number": "570-587-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANDALOWSKI",
        "first_name": "JOHN",
        "middle_name": "GERALD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-21",
        "last_updated": "2008-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD014228E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Paul Vilogi, M.D.
• Vision Innovation Centers of Pennsylvania LLC
• VL Enterprises, Inc
• David Alan Waibel, M.D.
• Rosemary Walsh, CCC-SLP
• Yao C Wang, M.D.
• David Washo, RRT RPSGT
• Stephanie Chapman Waters, L.S.W.
• Tara Marie Watkins, MA, LPC
• Mary Theresa Webb, RD, LDN, CDE

• Internal Medicine Physician in Clarks Summit, PA
• Providers in Clarks Summit, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.