Provider Demographics
NPI:1780696740
Name:WENSEL, ANDREW M (MD)
Entity type:Individual
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First Name:ANDREW
Middle Name:M
Last Name:WENSEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 670
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-467-1643
Mailing Address - Fax:585-342-4648
Practice Address - Street 1:1445 PORTLAND AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3036
Practice Address - Country:US
Practice Address - Phone:585-467-1643
Practice Address - Fax:585-342-4648
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-07-06
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Provider Licenses
StateLicense IDTaxonomies
NY234190207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03116543Medicaid
NY03116543Medicaid