Provider Demographics
NPI:1396066627
Name:WENGER, PETER CHRISTOPHER (MD,)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:CHRISTOPHER
Last Name:WENGER
Suffix:
Gender:M
Credentials:MD,
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG 4A STE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-896-9190
Mailing Address - Fax:609-896-3555
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG 4A STE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-9190
Practice Address - Fax:609-896-3555
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA088379002081S0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ175461OtherAIUM ULTRASOUND ACCREDITATION
NJ245222Medicare PIN