Wanderman, Richard G

Wanderman, Richard G is an sole proprietor health care provider with primary practice located at 4646 Poplar Ave Ste 302 , Memphis TN 38117-4433. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Allergy, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Adolescent Medicine. Allopathic & Osteopathic Physicians / Adolescent Medicine is his primary health care specialty. Wanderman, Richard G can be contacted via phone (901) 930-7397.

Contact Information

Primary practice address
4646 Poplar Ave Ste 302 Memphis TN 38117-4433
Phone: (901) 930-7397
Fax: (905) 552-3902
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy 207KA0200X 22468 Tennessee
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 22468 Tennessee
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 22468 Tennessee

Profile Details

NPI number 1184724312
LBN Legal business name Wanderman, Richard G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 25th, 2006
Last updated Oct 19th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184724312 NPPES
Tennessee MEDICAID 3194814

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