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NPI Code Detail

MEDICARE: DR. JACK TODD WAHRENBERGER M.D.

MEDICARE: DR. JACK TODD WAHRENBERGER 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
1207Q00000XFamily Medicine PhysicianMD 050618 LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396740767
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK TODD WAHRENBERGER M.D.
Provider Business Mailing Address
First Line : 249 S 9TH ST
Second Line :
City : PITTSBURGH
State : PA
Zip : 15203-1265
Country : US
Telephone Number : 412-697-3260
Fax Number :
Provider Business Practice Location Address
First Line : 249 S 9TH ST
Second Line :
City : PITTSBURGH
State : PA
Zip : 15203-1265
Country : US
Telephone Number : 412-697-3260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 01/14/2026

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