Basic Information
| Provider Information | |||||||||
| NPI: | 1285627810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTZ | ||||||||
| FirstName: | WENDELL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172677164 | ||||||||
| FaxNumber: | 7172677414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN328684L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1007307260035 | 01 | PA | MEDICAID GROUP # | OTHER | 120420418 | 01 | PA | DEPT OF LABOR | OTHER | 050514 | 01 | PA | GROUP MEDICARE # | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 50073152 | 01 | PA | CAPITAL BLUECROSS | OTHER | G920-0088/85XWCU | 01 | PA | CAREFIRST | OTHER | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | RN328684L | 01 | PA | LICENSE | OTHER | P00618649 | 01 | PA | RAILROAD MEDICARE | OTHER | 101983977 | 05 | PA | MEDICAID | 238574 | 01 | PA | UNISON | OTHER | PEARL PROVIDER | 01 | PA | HEALTH AMERICA | OTHER |