Provider Demographics
NPI:1396716239
Name:WETZLER, MERRICK (MD)
Entity type:Individual
Prefix:
First Name:MERRICK
Middle Name:
Last Name:WETZLER
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 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:502 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9544
Practice Address - Country:US
Practice Address - Phone:856-424-8866
Practice Address - Fax:856-424-5731
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06213900207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G08774Medicare UPIN
WE775688Medicare ID - Type Unspecified
NJ0523030001Medicare NSC
NJ077356 SK3Medicare PIN