Provider Demographics
NPI:1962676973
Name:WENGER, OLIVIA KAY (MD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KAY
Last Name:WENGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:KAY
Other - Last Name:STOLTZFUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:MOUNT EATON
Mailing Address - State:OH
Mailing Address - Zip Code:44659-0336
Mailing Address - Country:US
Mailing Address - Phone:330-359-9888
Mailing Address - Fax:330-359-9890
Practice Address - Street 1:15988B E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MOUNT EATON
Practice Address - State:OH
Practice Address - Zip Code:44659
Practice Address - Country:US
Practice Address - Phone:330-359-9888
Practice Address - Fax:330-359-9890
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089916208000000X
OH35089916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.089916OtherOH MEDICAL LICENSE