Provider Demographics
NPI:1649342726
Name:WIESELTIER, HARVEY R (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:R
Last Name:WIESELTIER
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 1:3500 5TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5053
Mailing Address - Country:US
Mailing Address - Phone:619-294-8459
Mailing Address - Fax:
Practice Address - Street 1:3500 5TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5053
Practice Address - Country:US
Practice Address - Phone:619-294-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50193207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery