Healthcare Provider Details

I. General information

NPI: 1487626800
Provider Name (Legal Business Name): PETER WECHGELAER MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CLINIC MCAS NEW RIVER PSC BOX 21034
JACKSONVILLE NC
28545-1034
US

IV. Provider business mailing address

102 OAK RIDGE DR
HAVELOCK NC
28532-9624
US

V. Phone/Fax

Practice location:
  • Phone: 910-449-6500
  • Fax: 910-449-6532
Mailing address:
  • Phone: 252-447-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101054690
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: