MEDICARE: WENDY RUMBLE VANBRONKHORST M.D.

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	208000000X	Pediatrics Physician	D0063345	MD
2	208000000X	Pediatrics Physician	0101232679	VA

General Provider Information

NPI Number	:	1992816938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY RUMBLE VANBRONKHORST M.D.

Provider Business Mailing Address
First Line	:	862 BAYRIDGE DR
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-1948
Country	:	US
Telephone Number	:	301-963-3721
Fax Number	:

Provider Business Practice Location Address
First Line	:	19803 EXECUTIVE PARK CIR
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2649
Country	:	US
Telephone Number	:	301-540-7496
Fax Number	:	301-540-0772

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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