Provider Demographics
NPI:1447256755
Name:WANNER, JEFFREY L (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:WANNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 OLD YORK RD
Mailing Address - Street 2:BRIARHOUSE
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1522
Mailing Address - Country:US
Mailing Address - Phone:215-885-8550
Mailing Address - Fax:215-885-8870
Practice Address - Street 1:8302 OLD YORK RD
Practice Address - Street 2:BRIARHOUSE
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1522
Practice Address - Country:US
Practice Address - Phone:215-885-8550
Practice Address - Fax:215-885-8870
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME166373208M00000X
PAMD065642L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA012573Medicare PIN