1568576593 NPI number — JOHN WEHRLE MD

Table of content: JOHN WEHRLE MD (NPI 1568576593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568576593 NPI number — JOHN WEHRLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEHRLE
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568576593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 WEST WAYNE PLAZA
Provider Second Line Business Mailing Address:
ROUTE 31
Provider Business Mailing Address City Name:
MACEDON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-986-1336
Provider Business Mailing Address Fax Number:
315-986-7208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 WEST WAYNE PLAZA
Provider Second Line Business Practice Location Address:
ROUTE 31
Provider Business Practice Location Address City Name:
MACEDON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-986-1336
Provider Business Practice Location Address Fax Number:
315-986-7208
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  198146 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080070337 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 080070337 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010198146 . This is a "RMSCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010198146 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: BLUE CHOICE . This is a "P010198146" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01575626 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101566BF . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3480 . This is a "ROCHESTER BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: CFP1981463 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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