Provider Demographics
NPI:1457391211
Name:VANBRAKLE, WENDYE C (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDYE
Middle Name:C
Last Name:VANBRAKLE
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 1:625 KENT AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3794
Mailing Address - Country:US
Mailing Address - Phone:301-722-2050
Mailing Address - Fax:301-722-2072
Practice Address - Street 1:625 KENT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3794
Practice Address - Country:US
Practice Address - Phone:301-722-2050
Practice Address - Fax:301-722-2072
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41403207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB39883Medicare UPIN
MD369MMedicare ID - Type Unspecified