Provider Demographics
NPI:1306197496
Name:WENDEL, BENJAMIN M (PA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:WENDEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ACCELERATOR WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3078
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:865-546-9047
Practice Address - Street 1:1600 ACCELERATOR WAY STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3078
Practice Address - Country:US
Practice Address - Phone:865-546-2663
Practice Address - Fax:865-546-9047
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2200363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4337380OtherBLUECROSS BLUESHIELD
TN4343172OtherBLUECROSS BLUESHIELD SURGERY ASSIST
TN1530256Medicaid
TNP01228945OtherRAILROAD MEDICARE
TN4343172OtherBLUECROSS BLUESHIELD SURGERY ASSIST
TN103I973310Medicare PIN