Provider Demographics
NPI:1033211891
Name:WENZEL, BRUCE ALLAN (DPM)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLAN
Last Name:WENZEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3223
Mailing Address - Country:US
Mailing Address - Phone:301-645-0366
Mailing Address - Fax:301-843-4773
Practice Address - Street 1:3261 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 1010
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3223
Practice Address - Country:US
Practice Address - Phone:301-645-0366
Practice Address - Fax:301-843-4773
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0399213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT73283Medicare UPIN
MD779MH995Medicare ID - Type Unspecified