Provider Demographics
NPI:1063459279
Name:WENZEL, DAVID JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:WENZEL
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:MARINO CENTER FOR PROGRESSIVE HEALTH
Mailing Address - Street 2:372 WASHINGTON STREET
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-235-5200
Mailing Address - Fax:781-235-1103
Practice Address - Street 1:MARINO CENTER FOR PROGRESSIVE HEALTH
Practice Address - Street 2:372 WASHINGTON STREET
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-235-5200
Practice Address - Fax:781-235-1103
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0401340OtherUNITED HEALTH CARE
MA081112OtherTUFTS
MABCBSOtherJ31278
MA690827OtherHARVARD PILGRIM
MA4254630OtherAETNA
MAB10183301OtherCIGNA
MAM21670OtherMEDICARE GROUP PROVIDER