Provider Demographics
NPI:1194813493
Name:WECHTER, MARY ELLEN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:WECHTER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 16568
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6568
Mailing Address - Country:US
Mailing Address - Phone:904-472-2300
Mailing Address - Fax:904-472-2330
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1600
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8334
Practice Address - Country:US
Practice Address - Phone:904-399-4862
Practice Address - Fax:904-402-8948
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101802207VG0400X, 207VG0400X
ORMD27515207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064350500Medicaid
FLAW897ZMedicare PIN
NCI06778Medicare UPIN
NC2026796Medicare ID - Type Unspecified
NC891364GMedicaid