Provider Demographics
NPI:1649434796
Name:WEDEL, MARISSA LINDSEY (MD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LINDSEY
Last Name:WEDEL
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:PENNSYLVANIA RETINA SPECIALISTS, PC
Mailing Address - Street 2:220 GRANDVIEW AVE, STE 200
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-761-8688
Mailing Address - Fax:
Practice Address - Street 1:PENNSYLVANIA RETINA SPECIALISTS, PC
Practice Address - Street 2:220 GRANDVIEW AVE, STE 200
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011
Practice Address - Country:US
Practice Address - Phone:717-761-8688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244113207W00000X, 207WX0107X
MA250672207W00000X
PAMD474785207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist