MEDICARE: CRAIG S WYNNE 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
1	208M00000X	Hospitalist Physician	MD048550L	PA
2	207R00000X	Internal Medicine Physician	MD048550L	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1538188073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG S WYNNE MD

Provider Business Mailing Address
First Line	:	3701 MARKET ST
Second Line	:	SUITE 640
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 MARKET ST
Second Line	:	SUITE 560W
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5502
Country	:	US
Telephone Number	:	215-662-2250
Fax Number	:	215-615-3995

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	09/27/2019

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Directions to “ CRAIG S WYNNE MD” Practice Location

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