DR. RICHARD G WANDERMAN MD - NPI 1184724312

Q: What is Richard Wanderman's NPI number?

The NPI number for Richard Wanderman is 1184724312. It was assigned to this individual provider in the NPPES registry on September 25, 2006.

Q: What is Richard Wanderman's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Q: When was this NPI record last updated?

The NPPES record for Richard Wanderman was last updated on October 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

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About Dr. Richard G Wanderman Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. RICHARD G WANDERMAN MD (NPI 1184724312) is an individual adolescent medicine provider in Memphis, Tennessee, licensed in Tennessee (22468) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1184724312

Entity TypeIndividualMale

Primary Taxonomy2080A0000X

Provider Legal NameDR. RICHARD G WANDERMANCredential: MD

Location Address4646 POPLAR AVE STE 302Memphis, TN 38117-4433

Mailing Address4646 Poplar Ave Ste 302Memphis, TN 38117-4433 · (901) 930-7397 · Fax (901) 552-3902

Phone(901) 930-7397

Fax(905) 552-3902

Sole ProprietorYes

Enumeration DateSeptember 25, 2006

Last NPPES UpdateOctober 19, 20222 updates tracked since enumeration

NPPES CertifiedOctober 19, 2022

✔ NPI 1184724312 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080A0000X

License✔ Licensed in TN · 22468

Definition

A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

Also ListedAllergy & Immunology · AllergyTaxonomy 207KA0200X · License 22468 (TN)

Also ListedFamily MedicineTaxonomy 207Q00000X · License 22468 (TN)

4646 POPLAR AVE STE 302, Memphis, TN 38117

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Other Identifiers 1

Medicaid3194814TN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of Tennessee, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Richard G Wanderman Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RAPHAEL WOODALL LCSW

Social Worker (Clinical)