Provider Demographics
NPI:1164948600
Name:WELLS, ARTHUR JAMES III
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:JAMES
Last Name:WELLS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MAXAMILLION
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2076
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-0076
Mailing Address - Country:US
Mailing Address - Phone:215-568-3633
Mailing Address - Fax:215-731-0194
Practice Address - Street 1:2035 CHESTNUT STREET
Practice Address - Street 2:APT. 408 1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-0076
Practice Address - Country:US
Practice Address - Phone:215-568-3633
Practice Address - Fax:215-731-0194
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABT000375L1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management