Provider Demographics
NPI:1700099215
Name:WENIGER, GERALD ROBERT (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ROBERT
Last Name:WENIGER
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:MR
Other - First Name:JERRY
Other - Middle Name:ROBERT
Other - Last Name:WENIGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, ATC
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:434-295-1000
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:545 RAY C HUNT DRIVE
Practice Address - Street 2:UVA ORTHOPAEDIC CENTER AT FONTAINE
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-0001
Practice Address - Country:US
Practice Address - Phone:434-243-5432
Practice Address - Fax:434-982-0012
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260006342255A2300X
VA0110002843363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700099215Medicaid