Provider Demographics
NPI:1124020078
Name:WELLS, MARION TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:TIMOTHY
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARION
Other - Middle Name:TIMOTHY
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:336 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5008
Mailing Address - Country:US
Mailing Address - Phone:828-262-9168
Mailing Address - Fax:828-262-4103
Practice Address - Street 1:336 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5008
Practice Address - Country:US
Practice Address - Phone:828-264-9664
Practice Address - Fax:828-262-4103
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22510207RC0000X, 207RI0011X
NC2022-00040207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT68575Medicaid
SC22510OtherSC LICENSE
SCT68575Medicaid