Active NPI
Lake Norman Ears Nose and Throat PA
- Otolaryngology Physician
- Mooresville, NC
National Provider Identifier
1306870902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- Legal business name
- LAKE NORMAN EARS NOSE AND THROAT PA
- Practice address
- 140 Gateway Blvd
Mooresville, NC 28117 - Phone
- (704) 664-9638
- Fax
- (704) 664-1859
- NPI assigned
- Jul 10, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Herbert Lee Wettreich, MD
- Title
- MD
- Phone
- (704) 664-9368
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | Primary |
Addresses
Primary practice location
140 Gateway Blvd
Mooresville, NC 28117
Mailing address
140 Gateway Blvd
Mooresville, NC 28117
Phone (704) 664-9638
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1781857 | Other | NC | UNITED HEALTHCARE |
| 8986676 | Medicaid | NC | |
| 0270K | Other | NC | BCBS |
| 5912716 | Medicaid | NC |
National Provider Directory
National Provider DirectoryLocations
140 Gateway Blvd
Mooresville, NC 28117
Phone (704) 664-9638
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1260316800000",
"number": "1306870902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 GATEWAY BLVD",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "28117",
"telephone_number": "704-664-9638",
"fax_number": "704-664-1859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 GATEWAY BLVD",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "28117",
"telephone_number": "704-664-9638",
"fax_number": "704-664-1859"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKE NORMAN EARS NOSE AND THROAT PA",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-10",
"last_updated": "2009-12-09",
"status": "A",
"authorized_official_last_name": "WETTREICH",
"authorized_official_first_name": "HERBERT",
"authorized_official_middle_name": "LEE",
"authorized_official_title_or_position": "MD",
"authorized_official_telephone_number": "704-664-9368",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1781857",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8986676",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0270K",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5912716",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mooresville, NC
- Lake Norman Compounding Pharmacy, Inc.
- Lake Norman Cosmetic and Restorative Dentistry
- Lake Norman Counseling & Pastoral Care Center
- Lake Norman Dermatology, PA
- Lake Norman Dialysis Center of Wake Forest University
- Lake Norman Emergency Medical Associates LLC
- Lake Norman Endocrinology & Diabetes, PC
- Lake Norman Eye OD PA
- Lake Norman Hematology and Oncology Specialists PA
- Lake Norman Hematology Oncology Specialists, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.