Provider Demographics
NPI:1831177302
Name:WETHERINGTON, ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:WETHERINGTON
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:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-0298
Mailing Address - Country:US
Mailing Address - Phone:937-725-1642
Mailing Address - Fax:937-393-6664
Practice Address - Street 1:1275 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8273
Practice Address - Country:US
Practice Address - Phone:937-393-6148
Practice Address - Fax:937-840-6663
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH284660460002OtherMEDICAL MUTUAL
OH000000390305OtherANTHEM
OH0112146OtherUNITED HEALTH CARE
OH311674981OtherHEALTH NET FEDERAL SERVIC
OH7722475OtherAETNA
OH2140061Medicaid
OH284660460002OtherMEDICAL MUTUAL