Healthcare Provider Details

I. General information

NPI: 1700099215
Provider Name (Legal Business Name): GERALD ROBERT WENIGER PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JERRY ROBERT WENIGER PA-C, ATC

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 RAY C HUNT DRIVE UVA ORTHOPAEDIC CENTER AT FONTAINE
CHARLOTTESVILLE VA
22903-0001
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-5432
  • Fax: 434-982-0012
Mailing address:
  • Phone: 434-295-1000
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110002843
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000634
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: