Provider Demographics
NPI:1992816938
Name:VANBRONKHORST, WENDY RUMBLE (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:RUMBLE
Last Name:VANBRONKHORST
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 1:862 BAYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1948
Mailing Address - Country:US
Mailing Address - Phone:301-963-3721
Mailing Address - Fax:
Practice Address - Street 1:19803 EXECUTIVE PARK CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2649
Practice Address - Country:US
Practice Address - Phone:301-540-7496
Practice Address - Fax:301-540-0772
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063345208000000X
VA0101232679208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics