Provider Demographics
NPI:1568576593
Name:WEHRLE, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WEHRLE
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 1:1900 WEST WAYNE PLAZA
Mailing Address - Street 2:ROUTE 31
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502
Mailing Address - Country:US
Mailing Address - Phone:315-986-1336
Mailing Address - Fax:315-986-7208
Practice Address - Street 1:1900 WEST WAYNE PLAZA
Practice Address - Street 2:ROUTE 31
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502
Practice Address - Country:US
Practice Address - Phone:315-986-1336
Practice Address - Fax:315-986-7208
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080070337OtherRAILROAD MEDICARE
080070337OtherRAILROAD MEDICARE
010198146OtherRMSCO
NYP010198146OtherBLUE CHOICE
BLUE CHOICEOtherP010198146
NY01575626Medicaid
101566BFOtherPREFERRED CARE
3480OtherROCHESTER BLUE SHIELD
NYCFP1981463OtherWORKERS COMPENSATION
3480OtherROCHESTER BLUE SHIELD
NYP010198146OtherBLUE CHOICE
B72210Medicare UPIN
NYG13829Medicare UPIN
NY01575626Medicaid