Provider Demographics
NPI:1770564346
Name:VANDER ARK, WESLEY DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:DEAN
Last Name:VANDER ARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N 21ST ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2223
Mailing Address - Country:US
Mailing Address - Phone:717-761-4844
Mailing Address - Fax:717-761-8953
Practice Address - Street 1:425 N 21ST ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2223
Practice Address - Country:US
Practice Address - Phone:717-761-4844
Practice Address - Fax:717-761-8953
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073620-L207Y00000X, 207YX0602X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA048971EDXMedicare ID - Type Unspecified
PAH40718Medicare UPIN