Provider Demographics
NPI:1083705198
Name:WEHBERG, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:WEHBERG
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 1:1415 WESLEY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7130
Mailing Address - Country:US
Mailing Address - Phone:410-912-7000
Mailing Address - Fax:410-912-4202
Practice Address - Street 1:1415 WESLEY DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7130
Practice Address - Country:US
Practice Address - Phone:410-912-7000
Practice Address - Fax:410-912-4202
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047664208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD421990200Medicaid
MDG14085Medicare UPIN