Individual
WOUTER J RIETSEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
75 BEEKMAN ST, PLATTSBURGH, NY 12901-1438
(518) 561-2000
(518) 561-0881
Mailing address
PO BOX 2868, PLATTSBURGH, NY 12901-0259
(518) 562-7900
(518) 562-7933
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
195737
NY
207RI0200X
Infectious Disease Physician
Primary
195737
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000405209002
BS OF NENY
NY
05
—
01561260
—
NY
01
—
044661958
HEALTH NET
NY
01
—
09004310
EMPIRE BC BS
NY
01
—
114406
VALUE OPTIONS
NY
01
—
119037
MVP
NY
01
—
141338471
GHI
NY
01
—
440002865
RAILROAD MEDICARE
NY
01
—
7423705
AETNA
NY
01
—
P010195737
EXCELLUS UTICA WATERTOWN
NY
Enumeration date
01/02/2007
Last updated
12/20/2012
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