Provider Demographics
NPI:1659384907
Name:WETZEL, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WETZEL
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 1:5 ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5660
Mailing Address - Country:US
Mailing Address - Phone:304-242-9778
Mailing Address - Fax:
Practice Address - Street 1:90 NORTH FOURTH STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935
Practice Address - Country:US
Practice Address - Phone:740-633-4127
Practice Address - Fax:740-633-4185
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074056207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000166068OtherANTHEM BC BS
OH2058375Medicaid
000000166068OtherANTHEM BC BS
OHG33938Medicare UPIN