Provider Demographics
NPI:1326014143
Name:WENRICH, BRYON P (PA)
Entity Type:Individual
Prefix:
First Name:BRYON
Middle Name:P
Last Name:WENRICH
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 1:100 E LANCASTER AVE
Mailing Address - Street 2:280 LANKENAU MEDICAL SCIENCE BLDG.
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-896-9255
Mailing Address - Fax:610-896-1947
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:280 LANKENAU MEDICAL SCIENCE BLDG.
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-896-9255
Practice Address - Fax:610-896-1947
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003159L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q54574Medicare UPIN
PA095345HK1Medicare ID - Type Unspecified