Individual
JODI KIM WENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
850 HARRISON AVE, YACC 5, BOSTON, MA 02118-4001
(617) 414-4841
(617) 414-4547
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
150364
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008157
—
VT
05
—
110090349A
—
MA
05
—
30201703
—
NH
Enumeration date
08/13/2006
Last updated
07/17/2014
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