Provider Demographics
NPI:1083805006
Name:WERTMAN, GARY VAN II (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:VAN
Last Name:WERTMAN
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:910-332-3800
Mailing Address - Fax:
Practice Address - Street 1:2145 COUNTRY CLUB RD STE 800
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-2404
Practice Address - Country:US
Practice Address - Phone:910-939-5759
Practice Address - Fax:910-939-4951
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201101058207X00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2086Medicaid
NC1083805006Medicaid
SCNC2086Medicaid
NCNC1729AMedicare PIN