Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD039654L | PA |
NPI | 1033204417 |
---|---|
Provider Name | Dr. Robert K Wenger |
First Address | Philadelphia, PA 19106-3585 |
Second Address | Philadelphia, PA 19106-3585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 27/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014659970005 | (05) | PA |
F65638 | (02) | FL |