Individual
MARK A WENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
511 PARK HILL DR, FREDERICKSBURG, VA 22401-3377
(540) 371-5660
(540) 372-6920
Mailing address
DEPT. 453 PO BOX 1000, MEMPHIS, TN 38148-0001
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
0101059064
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006254A38
MEDICARE PTAN
VA
05
—
1336139666
—
VA
Enumeration date
10/27/2005
Last updated
06/06/2022
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