Provider Demographics
NPI:1265453609
Name:WETZEL, ALLEN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:ANTHONY
Last Name:WETZEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:246 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737-1614
Practice Address - Country:US
Practice Address - Phone:570-584-5144
Practice Address - Fax:570-584-5416
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD427248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017330250003Medicaid
PA102979F6KMedicare PIN
PAI58158Medicare UPIN
PA1017330250001Medicaid
PA102979Medicare PIN