Provider Demographics
NPI:1457328064
Name:VETTER, PAUL LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LOUIS
Last Name:VETTER
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 1:1140 BURNT TAVERN RD
Mailing Address - Street 2:STE 2A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1496
Mailing Address - Country:US
Mailing Address - Phone:732-202-0700
Mailing Address - Fax:732-202-0664
Practice Address - Street 1:1140 BURNT TAVERN RD
Practice Address - Street 2:STE 2A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1496
Practice Address - Country:US
Practice Address - Phone:732-202-0700
Practice Address - Fax:732-202-0664
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059615207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7061404Medicaid
G80145Medicare UPIN
NJ7061404Medicaid