Provider Demographics
NPI:1255421806
Name:WENZEL, RICHARD P (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:WENZEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:PUTNAM
Other - Last Name:WENZEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 980403
Mailing Address - Street 2:830 EAST MAIN ST 2ND FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0403
Mailing Address - Country:US
Mailing Address - Phone:804-828-5388
Mailing Address - Fax:804-628-2769
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:828-338-9804
Practice Address - Fax:828-556-6804
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022804207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6048587Medicaid
A03105Medicare UPIN
VA6048587Medicaid