Provider Demographics
NPI:1700815131
Name:WENGER, JOHN D (DO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:WENGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:540-564-5400
Mailing Address - Fax:757-579-8560
Practice Address - Street 1:1931 MEDICAL AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3437
Practice Address - Country:US
Practice Address - Phone:540-564-5400
Practice Address - Fax:757-579-8560
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006884207Q00000X
VA0102202366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700815131Medicaid
020426R54Medicare PIN