Provider Demographics
NPI:1720142599
Name:WENINGER, MARVIN GEORGE (MD)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:GEORGE
Last Name:WENINGER
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 1:11407 COUCH MILL RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2908
Mailing Address - Country:US
Mailing Address - Phone:865-927-2220
Mailing Address - Fax:
Practice Address - Street 1:11407 COUCH MILL RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-2908
Practice Address - Country:US
Practice Address - Phone:865-927-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0086532084P0800X
CAG863052084P0800X
AK34742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD34743Medicaid
TN3871762Medicare ID - Type Unspecified
TNB03409Medicare UPIN
TNBO3409Medicare UPIN