Provider Demographics
NPI:1447254073
Name:NEWELL, WENDY (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WOLF CREEK BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4915
Mailing Address - Country:US
Mailing Address - Phone:302-674-2420
Mailing Address - Fax:302-674-4473
Practice Address - Street 1:103 WOLF CREEK BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4915
Practice Address - Country:US
Practice Address - Phone:302-674-2420
Practice Address - Fax:302-674-4473
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004392174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001156301Medicaid
00A780H59Medicare ID - Type Unspecified
DE0001156301Medicaid