Basic Information
| Provider Information | |||||||||
| NPI: | 1972815132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WERT | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1534 PARK AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | QUAKERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189511084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155386430 | ||||||||
| FaxNumber: | 4848937098 | ||||||||
| Practice Location | |||||||||
| Address1: | 1534 PARK AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | QUAKERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189511084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155386430 | ||||||||
| FaxNumber: | 4848937098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2010 | ||||||||
| LastUpdateDate: | 07/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | OS017015 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | OS017015 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102432382 | 05 | PA | MEDICAID |