Provider Demographics
NPI:1801853684
Name:WENICK, DIANE F (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:F
Last Name:WENICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7863
Mailing Address - Country:US
Mailing Address - Phone:203-794-1979
Mailing Address - Fax:203-794-1796
Practice Address - Street 1:132 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7863
Practice Address - Country:US
Practice Address - Phone:203-794-1979
Practice Address - Fax:203-794-1796
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001284025Medicaid
B84618Medicare UPIN
CT001284025Medicaid