Provider Demographics
NPI:1356336697
Name:WENZEL, CHRISTOPHER T (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:T
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 1:63 HAYWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-4404
Mailing Address - Country:US
Mailing Address - Phone:828-627-1234
Mailing Address - Fax:828-627-6706
Practice Address - Street 1:63 HAYWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-4404
Practice Address - Country:US
Practice Address - Phone:828-627-1234
Practice Address - Fax:828-627-6706
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127F1Medicaid
H20787Medicare UPIN
NC89127F1Medicaid