Healthcare Provider Details

I. General information

NPI: 1508446659
Provider Name (Legal Business Name): MICHAEL THOMAS WEINGARTEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E MAIN ST
PENDLETON SC
29670-1308
US

IV. Provider business mailing address

220 E MAIN ST
PENDLETON SC
29670-1308
US

V. Phone/Fax

Practice location:
  • Phone: 864-737-1722
  • Fax: 864-372-1131
Mailing address:
  • Phone: 864-737-1722
  • Fax: 864-372-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83652
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: