Provider Demographics
NPI:1336139666
Name:WENGER, MARK A (M D)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:WENGER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Mailing Address - Street 1:DEPT. 453 PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:511 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3377
Practice Address - Country:US
Practice Address - Phone:540-371-5660
Practice Address - Fax:540-372-6920
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101059064207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336139666Medicaid
VA006254A38OtherMEDICARE PTAN
VA02-00461OtherUNITED HEALTHCARE
VA010115116Medicaid
VA3789353OtherAETNA
VA561249571OtherCIGNA
VA561249571OtherVA HEALTH NETWORK
VA006254A38OtherMEDICARE PTAN
VA3129595OtherALLIANCE/MAMSI
VA7247254OtherAETNA
VABLUE CROSSOther172754
VAJ063-0003OtherCAREFIRST
VA255384OtherSOUTHERN HEALTH
VA561249571OtherVA HEALTH NETWORK
VAP00217149Medicare PIN