Provider Demographics
NPI:1366431272
Name:WENIGER, FREDERICK G (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:G
Last Name:WENIGER
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 1:350 FORDING ISLAND ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:843-757-0123
Mailing Address - Fax:843-757-0329
Practice Address - Street 1:350 FORDING ISLAND ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-757-0123
Practice Address - Fax:843-757-0329
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27893208200000X
GA056381208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG56381Medicaid
SC205048337OtherBCBS PROVIDER NUMBER
SCI380068556Medicare PIN
SCI38006Medicare UPIN