Provider Demographics
NPI:1285627810
Name:MARTZ, WENDELL D (CRNA)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:D
Last Name:MARTZ
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1700
Practice Address - Country:US
Practice Address - Phone:717-267-7164
Practice Address - Fax:717-267-7414
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2021-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PARN328684L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007307260035OtherMEDICAID GROUP #
PA120420418OtherDEPT OF LABOR
PA050514OtherGROUP MEDICARE #
PA25-1716306OtherHEALTHNET/TRICARE
PA50073152OtherCAPITAL BLUECROSS
PAG920-0088/85XWCUOtherCAREFIRST
PA25-1716306OtherFIRST HEALTH
PARN328684LOtherLICENSE
PAP00618649OtherRAILROAD MEDICARE
PA101983977Medicaid
PA238574OtherUNISON
PAPEARL PROVIDEROtherHEALTH AMERICA
PAG920-0088/85XWCUOtherCAREFIRST