Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD425095 | PA |
NPI | 1104852946 |
---|---|
Provider Name | Matthew Merle Wetzel |
First Address | Greensburg, PA 15601-6480 |
Second Address | Greensburg, PA 15601-6480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 02/01/2015 |