Provider Demographics
NPI:1326036526
Name:WENGER, ALLEN S (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:S
Last Name:WENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N 21ST ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2207
Mailing Address - Country:US
Mailing Address - Phone:717-763-1174
Mailing Address - Fax:717-763-8960
Practice Address - Street 1:423 N 21ST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2207
Practice Address - Country:US
Practice Address - Phone:717-763-1174
Practice Address - Fax:717-763-8960
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD035202E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
192801J5EMedicare ID - Type Unspecified
B41002Medicare UPIN