MEDICARE: DR. WAYNE HENTSCHEL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS-OO6741-L	PA

General Provider Information

NPI Number	:	1063549806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE HENTSCHEL D.O.

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	CHESTER HEIGHTS
State	:	PA
Zip	:	19017-0307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 ISLAND AVE
Second Line	:	SUITE 147
City	:	PHILA
State	:	PA
Zip	:	19153-2300
Country	:	US
Telephone Number	:	212-863-2320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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