Healthcare Provider Details

I. General information

NPI: 1912007675
Provider Name (Legal Business Name): ROBERT E. WENGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LIFE OF PURPOSE 1035 VIRGINIA DRIVE, SUITE 120
FORT WASHINGTON PA
19034-1903
US

IV. Provider business mailing address

811 ALENE RD
AMBLER PA
19002-2607
US

V. Phone/Fax

Practice location:
  • Phone: 267-419-7710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD016115E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: