Provider Demographics
NPI:1063497113
Name:WECHMAN, RAYMOND JR (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:WECHMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1138 LEXINGTON RD
Mailing Address - Street 2:STE 130
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9672
Mailing Address - Country:US
Mailing Address - Phone:502-867-0222
Mailing Address - Fax:502-867-0420
Practice Address - Street 1:1138 LEXINGTON RD
Practice Address - Street 2:STE 130
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9672
Practice Address - Country:US
Practice Address - Phone:502-867-0222
Practice Address - Fax:502-867-0420
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY25343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64253438Medicaid
KY64253438Medicaid
C68673Medicare UPIN