Healthcare Provider Details

I. General information

NPI: 1164589651
Provider Name (Legal Business Name): MICHAEL SCOTT WETZEL P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 SCHOENERSVILLE RD STE 104
BETHLEHEM PA
18017-7317
US

IV. Provider business mailing address

931 N 32ND ST
ALLENTOWN PA
18104-3403
US

V. Phone/Fax

Practice location:
  • Phone: 484-884-1011
  • Fax: 484-884-1012
Mailing address:
  • Phone: 973-879-3597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055843
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA055843
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00074400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: