Provider Demographics
NPI:1447754155
Name:WENZINGER, ERIC JOSEPH
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSEPH
Last Name:WENZINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2344
Mailing Address - Country:US
Mailing Address - Phone:803-931-6089
Mailing Address - Fax:
Practice Address - Street 1:2060 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2344
Practice Address - Country:US
Practice Address - Phone:803-931-6089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program