Provider Demographics
NPI:1124373725
Name:WINTZ, PHYLLIS WOCKLISH (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:WOCKLISH
Last Name:WINTZ
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 1:3 YOUNG CT
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-1250
Mailing Address - Country:US
Mailing Address - Phone:610-777-3180
Mailing Address - Fax:
Practice Address - Street 1:3 YOUNG CT
Practice Address - Street 2:
Practice Address - City:MOHNTON
Practice Address - State:PA
Practice Address - Zip Code:19540-1250
Practice Address - Country:US
Practice Address - Phone:610-777-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043680L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology