MEDICARE: T WANGDI SHERPA 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	207Q00000X	Family Medicine Physician	MD065527L	PA

General Provider Information

NPI Number	:	1124021845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	T WANGDI SHERPA M.D.

Provider Business Mailing Address
First Line	:	431 W LINCOLN AVE
Second Line	:
City	:	MYERSTOWN
State	:	PA
Zip	:	17067-2328
Country	:	US
Telephone Number	:	717-866-5755
Fax Number	:	717-866-7120

Provider Business Practice Location Address
First Line	:	431 W LINCOLN AVE
Second Line	:
City	:	MYERSTOWN
State	:	PA
Zip	:	17067-2328
Country	:	US
Telephone Number	:	717-866-5755
Fax Number	:	717-866-7120

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/07/2012

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