Provider Demographics
NPI:1558487439
Name:ROBERT J. WETZEL
Entity Type:Organization
Organization Name:ROBERT J. WETZEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-633-4127
Mailing Address - Street 1:90 N 4TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1648
Mailing Address - Country:US
Mailing Address - Phone:740-633-4127
Mailing Address - Fax:740-633-4185
Practice Address - Street 1:90 N 4TH ST FL 2
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1648
Practice Address - Country:US
Practice Address - Phone:740-633-4127
Practice Address - Fax:740-633-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074056207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0093753000Medicaid
000000166068OtherBC BS
OH2058375Medicaid
WV0093753000Medicaid