Provider Demographics
NPI:1780682104
Name:WENNER, EARL J JR (DO)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:J
Last Name:WENNER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RATHTON RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3717
Mailing Address - Country:US
Mailing Address - Phone:717-846-3877
Mailing Address - Fax:717-845-6141
Practice Address - Street 1:9 RATHTON RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3717
Practice Address - Country:US
Practice Address - Phone:717-846-3877
Practice Address - Fax:717-845-6141
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-10
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004371L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC33339Medicare UPIN
PA197925Medicare PIN