Healthcare Provider Details

I. General information

NPI: 1447754155
Provider Name (Legal Business Name): ERIC JOSEPH WENZINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1674 FOLLY RD APT 715
CHARLESTON SC
29412-8720
US

IV. Provider business mailing address

1674 FOLLY RD APT 715
CHARLESTON SC
29412-8720
US

V. Phone/Fax

Practice location:
  • Phone: 803-931-6089
  • Fax:
Mailing address:
  • Phone: 617-655-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number95681
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: