Provider Demographics
NPI:1871591511
Name:SCHETTLER, HERBERT H (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:H
Last Name:SCHETTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 LITCHFIELD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-496-8990
Mailing Address - Fax:860-496-7301
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-496-8990
Practice Address - Fax:860-496-7301
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017353174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0000031102002OtherUNITED HEALTHCARE ID
CT010017353CT01OtherBLUE SHIELD PROVIDER ID
CT017353OtherCONNECTICARE PROVIDER ID
CT1173533Medicaid
CT4314444OtherAETNA PROVIDER ID
CTP531102OtherOXFORD PROVIDER ID
CT00117353300OtherBLUE CARE FAMILY PLAN ID
CT041414OtherHEALTHNET PROVIDER ID
CTP531102OtherOXFORD PROVIDER ID