Provider Demographics
NPI:1841280914
Name:WETHERILL, STEPHEN FRAZIER (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FRAZIER
Last Name:WETHERILL
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 1:2700 SILVERSIDE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3719
Mailing Address - Country:US
Mailing Address - Phone:302-478-3700
Mailing Address - Fax:302-478-4444
Practice Address - Street 1:2700 SILVERSIDE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3719
Practice Address - Country:US
Practice Address - Phone:302-478-3700
Practice Address - Fax:302-478-4444
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000909207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC10000909OtherLICENSE #
DE149276Medicare PIN
DEC10000909OtherLICENSE #