Healthcare Provider Details

I. General information

NPI: 1487660775
Provider Name (Legal Business Name): NORMAN A HETZLER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 HIGH ST STE 1E
PORTSMOUTH VA
23707-3213
US

IV. Provider business mailing address

PO BOX 88 5 E ALVON ROAD SUITE 7
WHITE SULPHUR SPRINGS WV
24986-2373
US

V. Phone/Fax

Practice location:
  • Phone: 757-398-2222
  • Fax:
Mailing address:
  • Phone: 304-536-5030
  • Fax: 304-536-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberTMP02476
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number46710
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD03596SE
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101285915
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: