Provider Demographics
NPI:1164866091
Name:WENNELL, RYAN CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:WENNELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PETERS RD STE 200-201
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7685
Mailing Address - Country:US
Mailing Address - Phone:717-626-2167
Mailing Address - Fax:717-626-1915
Practice Address - Street 1:51 PETERS RD STE 200-201
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7685
Practice Address - Country:US
Practice Address - Phone:717-626-2167
Practice Address - Fax:717-626-1915
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018047207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031217640001Medicare PIN
PA512124FLTMedicare PIN