Healthcare Provider Details

I. General information

NPI: 1962473199
Provider Name (Legal Business Name): FREDERICK G WENZEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 AMHERST ST
WINCHESTER VA
22601-2803
US

IV. Provider business mailing address

1514 AMHERST ST
WINCHESTER VA
22601-2803
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-4499
  • Fax: 540-722-4172
Mailing address:
  • Phone: 540-667-4499
  • Fax: 540-722-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101055577
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0101055577
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number0101055577
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number18997
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number18997
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number18997
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: