MEDICARE: CHRISTOPHER MARK WANKA

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	363A00000X	Physician Assistant	C08975	MD

General Provider Information

NPI Number	:	1942967856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MARK WANKA

Provider Business Mailing Address
First Line	:	PO BOX 23408
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-0530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 HARRY S TRUMAN DR N
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5477
Country	:	US
Telephone Number	:	240-677-1000
Fax Number	:

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

Provider Enumeration Date	:	11/26/2021
Last Update Date	:	03/05/2026

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