Provider Demographics
NPI:1548211683
Name:WETZEL, GEHRED D (DO)
Entity Type:Individual
Prefix:DR
First Name:GEHRED
Middle Name:D
Last Name:WETZEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:10 TRIEBLE DR
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7054
Practice Address - Country:US
Practice Address - Phone:570-996-2700
Practice Address - Fax:570-996-2711
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007644L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001534664Medicaid
G09458Medicare UPIN
PA785683Medicare ID - Type Unspecified