Provider Demographics
NPI:1295756880
Name:WENDEL, DANIEL T (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:T
Last Name:WENDEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5473 VILLAGE COMMON DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4961
Mailing Address - Country:US
Mailing Address - Phone:814-833-3223
Mailing Address - Fax:814-833-5763
Practice Address - Street 1:5473 VILLAGE COMMON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4961
Practice Address - Country:US
Practice Address - Phone:814-833-3223
Practice Address - Fax:814-833-5763
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006273L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA742097OtherHIGHMARK BLUE SHIELD
PA0014058810004Medicaid
PA0014058810004Medicaid
PAE91263Medicare UPIN