Provider Demographics
NPI:1215396866
Name:WECHSLER, MICHAEL JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:WECHSLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 FAIRVIEW AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3915
Mailing Address - Country:US
Mailing Address - Phone:610-923-5200
Mailing Address - Fax:610-923-5272
Practice Address - Street 1:2005 FAIRVIEW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3915
Practice Address - Country:US
Practice Address - Phone:610-923-5200
Practice Address - Fax:610-923-5272
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058067363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA487240V8GMedicare PIN