Provider Demographics
NPI:1184727190
Name:RISSINGER, WENDY ANN (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:RISSINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1244 STATE ROUTE 225
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:PA
Practice Address - Zip Code:17830-7324
Practice Address - Country:US
Practice Address - Phone:571-758-3511
Practice Address - Fax:570-758-4736
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2015-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD428048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017227380001Medicaid
PA1017227380001Medicaid