MEDICARE: MADELEINE WETZEL

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
1	363AM0700X	Medical Physician Assistant	MA063272	OH

General Provider Information

NPI Number	:	1760140040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEINE WETZEL

Provider Business Mailing Address
First Line	:	7131 RIDGE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-3251
Country	:	US
Telephone Number	:	215-483-2113
Fax Number	:

Provider Business Practice Location Address
First Line	:	7131 RIDGE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-3251
Country	:	US
Telephone Number	:	215-483-2113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2021
Last Update Date	:	02/23/2022

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Directions to “ MADELEINE WETZEL ” Practice Location

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