Provider Demographics
NPI:1629120621
Name:VANDYKE, WENDY A (DO)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:A
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20528 BOLAND FARM RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4021
Mailing Address - Country:US
Mailing Address - Phone:301-972-0400
Mailing Address - Fax:301-916-1453
Practice Address - Street 1:20528 BOLAND FARM RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4021
Practice Address - Country:US
Practice Address - Phone:301-972-0400
Practice Address - Fax:301-916-1453
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0059018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBV6892904OtherDEA
MDBV6892904OtherDEA