Provider Demographics
NPI:1811139199
Name:BOBB, WENDELL TORRANCE (MD)
Entity type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:TORRANCE
Last Name:BOBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1428
Mailing Address - Country:US
Mailing Address - Phone:850-445-8653
Mailing Address - Fax:410-740-1518
Practice Address - Street 1:6314 2ND ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1428
Practice Address - Country:US
Practice Address - Phone:850-445-8653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0457092084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty