Healthcare Provider Details

I. General information

NPI: 1013143742
Provider Name (Legal Business Name): ANDREW KENNETH ETZEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 CHAPLINE ST
WHEELING WV
26003-3859
US

IV. Provider business mailing address

109 MOUNT WOOD RD
WHEELING WV
26003-2632
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-8885
  • Fax:
Mailing address:
  • Phone: 304-234-2455
  • Fax: 304-233-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2251
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: