Individual
BARRY J WANNINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3000 MACK RD, FAIRFIELD, OH 45014-5335
(516) 870-7001
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.003612
OH
Other
Enumeration date
10/16/2012
Last updated
10/31/2012
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