Healthcare Provider Details

I. General information

NPI: 1912584392
Provider Name (Legal Business Name): BRITTANY MICHELLE WENGER MD (GRAD DT 5/14/21)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC NEONATAL-PERINATAL MEDICINE
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC NEONATAL-PERINATAL MEDICINE
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3083
  • Fax:
Mailing address:
  • Phone: 215-590-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMT230971
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: