Organization
WELLNESSMD @ ACAC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHIL G WENDEL (OWNER)
(434) 974-9890
Entity
Organization
Contact information
Practice address
406 ALBEMARLE SQ, CHARLOTTESVILLE, VA 22901-1472
(434) 817-4280
(434) 817-4281
Mailing address
406 ALBEMARLE SQUARE, CHARLOTTESVILLE, VA 22901-1472
(434) 817-4280
(434) 817-4281
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00X553W38
INDIVIDUAL TPAN
—
01
—
C10038
GROUP PTAN
—
Enumeration date
10/03/2007
Last updated
04/22/2008
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