Provider Demographics
NPI:1073807210
Name:STEPHENSON, WENDY P (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:P
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 CARMEL PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3131
Mailing Address - Country:US
Mailing Address - Phone:215-628-2755
Mailing Address - Fax:
Practice Address - Street 1:1816 CARMEL PL
Practice Address - Street 2:
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002-3131
Practice Address - Country:US
Practice Address - Phone:215-628-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041572E2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine