Provider Demographics
NPI:1962473199
Name:WENZEL, FREDERICK G (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:G
Last Name:WENZEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2803
Mailing Address - Country:US
Mailing Address - Phone:540-667-4499
Mailing Address - Fax:540-722-4172
Practice Address - Street 1:1514 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2803
Practice Address - Country:US
Practice Address - Phone:540-667-4499
Practice Address - Fax:540-722-4172
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055577207N00000X, 207NS0135X, 207ND0900X
WV18997207N00000X, 207NS0135X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000958571OtherMTST BCBS
WV0070147000Medicaid
VA231484OtherANTHEM BCBS
VA005900867Medicaid
WV000958571OtherMTST BCBS
VAG46295Medicare UPIN
WVWE4029301Medicare ID - Type Unspecified