Individual provider Active NPI

Mark A Wenger, M. D.

  • Allergy & Immunology Physician
  • Fredericksburg, VA
National Provider Identifier
1336139666
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
0101059064 Issued in VA
Practice address
511 Park Hill Dr
Fredericksburg, VA 22401-3377
Phone
(540) 371-5660
Fax
(540) 372-6920
NPI assigned
Oct 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 0101059064 VA Primary

Addresses

Primary practice location

511 Park Hill Dr
Fredericksburg, VA 22401-3377

Mailing address

Dept. 453 PO Box 1000
Memphis, TN 38148-0001
Phone (828) 575-2625

Other identifiers 2

IdentifierTypeStateIssuer
1336139666MedicaidVA
006254A38OtherVAMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101059064VAMDAllergy & Immunology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1336139666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT. 453 PO BOX 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480001",
            "telephone_number": "828-575-2625",
            "fax_number": "828-350-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 PARK HILL DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224013377",
            "telephone_number": "540-371-5660",
            "fax_number": "540-372-6920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENGER",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "M. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "VA",
            "license": "0101059064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336139666",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "006254A38",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.