Provider Demographics
NPI:1659553451
Name:WETTER, JEREMY (PA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:WETTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20528 BOLAND FARM RD
Mailing Address - Street 2:STE 104
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4032
Mailing Address - Country:US
Mailing Address - Phone:301-972-0400
Mailing Address - Fax:301-916-1453
Practice Address - Street 1:20528 BOLAND FARM RD
Practice Address - Street 2:STE 104
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4032
Practice Address - Country:US
Practice Address - Phone:301-972-0400
Practice Address - Fax:301-916-1453
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical