Provider Demographics
NPI:1356528673
Name:WETHERTON, ANGELA RAWLINS (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:RAWLINS
Last Name:WETHERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1428
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-367-3365
Practice Address - Street 1:200 E CHESTNUT ST BLDG SUITE303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100134030Medicaid
IN201003310Medicaid
KYK021662OtherMEDICARE
KYP01228933OtherMEDICARE RR
KYP400027603Medicare PIN
KYP400027600Medicare PIN
KYP400027602Medicare PIN