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NPI Code Detail

MEDICARE: TIERNEY ELIZABETH WOLGEMUTH MD

MEDICARE: TIERNEY ELIZABETH WOLGEMUTH MD
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
1207V00000XObstetrics & Gynecology Physician125075538IL

General Provider Information

NPI Number : 1407482300
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIERNEY ELIZABETH WOLGEMUTH MD
Provider Business Mailing Address
First Line : 694 GOOD DR STE 11
Second Line :
City : LANCASTER
State : PA
Zip : 17601-2433
Country : US
Telephone Number : 603-316-0648
Fax Number :
Provider Business Practice Location Address
First Line : 690 GOOD DR
Second Line :
City : LANCASTER
State : PA
Zip : 17601-2433
Country : US
Telephone Number : 603-316-0648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2020
Last Update Date : 02/05/2026

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