Provider Demographics
NPI:1467411983
Name:WENGER, EVAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:JAMES
Last Name:WENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5275
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:57 N MEDICAL PARK DR STE 109
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2353
Practice Address - Country:US
Practice Address - Phone:540-332-4169
Practice Address - Fax:540-332-4168
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012327812084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C04857OtherMEDICARE GROUP NUMBER
C04857OtherMEDICARE GROUP NUMBER