Provider Demographics
NPI:1053481150
Name:WERMUTH, WAYNE BARRY (MED)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:BARRY
Last Name:WERMUTH
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 CLEARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5405
Mailing Address - Country:US
Mailing Address - Phone:610-821-8866
Mailing Address - Fax:610-366-1960
Practice Address - Street 1:1145 CLEARWOOD DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5405
Practice Address - Country:US
Practice Address - Phone:610-821-8866
Practice Address - Fax:610-366-1960
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-001275-L103T00000X
PAPF-00106-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03101301OtherCAPITAL ADVANTAGE INS. CO