Provider Demographics
NPI:1326025420
Name:MUELLO, WENDY GAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:GAIR
Last Name:MUELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:SUE
Other - Last Name:MUELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:345 PRESIDENTIAL HWY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NH
Mailing Address - Zip Code:03583
Mailing Address - Country:US
Mailing Address - Phone:603-631-0788
Mailing Address - Fax:603-788-5027
Practice Address - Street 1:345 PRESIDENTIAL HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NH
Practice Address - Zip Code:03583
Practice Address - Country:US
Practice Address - Phone:603-631-0788
Practice Address - Fax:603-788-5027
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002335Medicaid
NH30002634Medicaid
NHB60141Medicare UPIN
NH30002634Medicaid