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NPI Code Detail

MEDICARE: STEWART WETCHLER & MARY KAY DINEEN

MEDICARE: STEWART WETCHLER & MARY KAY DINEEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist0101028577VA

General Provider Information

NPI Number : 1730278243
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEWART WETCHLER & MARY KAY DINEEN
Provider Business Mailing Address
First Line : 12700 MCMANUS BLVD
Second Line : SUITE 102A
City : NEWPORT NEWS
State : VA
Zip : 23602-4407
Country : US
Telephone Number : 757-874-8696
Fax Number : 757-872-9904
Provider Business Practice Location Address
First Line : 12700 MCMANUS BLVD
Second Line : SUITE 102A
City : NEWPORT NEWS
State : VA
Zip : 23602-4407
Country : US
Telephone Number : 757-874-8696
Fax Number : 757-872-9904
Authorized Official
Title or Position : OWNER
Name : STEWART JAMES WETCHLER
Credential : M.D.
Telephone Number : 757-874-8696
Provider Enumeration Date : 10/12/2006
Last Update Date : 08/22/2020

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