MEDICARE: WENDY HEROLD PALASTRO 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	207Q00000X	Family Medicine Physician	D85437	MD
2	207Q00000X	Family Medicine Physician	294120	NY
3	207Q00000X	Family Medicine Physician	2023-00840	NC
4	207Q00000X	Family Medicine Physician	4301115462	MI
5	207Q00000X	Family Medicine Physician	25MA11907100	NJ
6	207Q00000X	Family Medicine Physician	98619	GA
7	207Q00000X	Family Medicine Physician	0101276813	VA
8	207Q00000X	Family Medicine Physician	275516	MA
9	207Q00000X	Family Medicine Physician	ME136342	FL
10	207Q00000X	Family Medicine Physician	73091	MN
11	207Q00000X	Family Medicine Physician	2022041313	MO
12	207Q00000X	Family Medicine Physician	C184245	CA
13	207Q00000X	Family Medicine Physician	E-15932	AR
14	207Q00000X	Family Medicine Physician	MD451765	PA

General Provider Information

NPI Number	:	1639462419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY HEROLD PALASTRO MD

Provider Business Mailing Address
First Line	:	533 E GIRARD AVE STE 27046
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 W TAYLOR ST STE 227
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4623
Country	:	US
Telephone Number	:	888-805-0085
Fax Number	:

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

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	06/13/2025

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