Provider Demographics
NPI:1568564342
Name:WENGER, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
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 1:153 COLLIER DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230-1208
Mailing Address - Country:US
Mailing Address - Phone:330-658-1550
Mailing Address - Fax:330-658-1699
Practice Address - Street 1:153 COLLIER DR
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:OH
Practice Address - Zip Code:44230-1208
Practice Address - Country:US
Practice Address - Phone:330-658-1550
Practice Address - Fax:330-658-1699
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2573979Medicaid
OHH414370Medicare UPIN
OHI33573Medicare UPIN