Provider Demographics
NPI:1215008545
Name:WETTREICH, HERBERT LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:LEE
Last Name:WETTREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:140 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9045
Mailing Address - Country:US
Mailing Address - Phone:704-664-9638
Mailing Address - Fax:704-664-1859
Practice Address - Street 1:140 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8522
Practice Address - Country:US
Practice Address - Phone:704-664-9638
Practice Address - Fax:704-664-1859
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39712207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8195OtherPARTNERS MEDICARE CHOICE
NC86676OtherBCBS
NC0270KOtherBCBS PRACTICE ID
NC47702OtherMEDCOST
NC562110704-002OtherCIGNA
NC5912716Medicaid
NC4402396OtherAETNA
NC835501OtherUNITED HEALTHCARE
NC8986676Medicaid
NC0270KOtherBCBS PRACTICE ID
NC86676OtherBCBS