Provider Demographics
NPI:1235187998
Name:WHEELER, COLEEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:COLEEN
Middle Name:G
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLEEN
Other - Middle Name:G
Other - Last Name:GOSNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7219 MCKNIGHT RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3524
Mailing Address - Country:US
Mailing Address - Phone:412-367-3278
Mailing Address - Fax:412-367-5083
Practice Address - Street 1:7219 MCKNIGHT RD
Practice Address - Street 2:SUITE F
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3524
Practice Address - Country:US
Practice Address - Phone:412-367-3278
Practice Address - Fax:412-367-5083
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056354L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015409752Medicaid
PA0015409752Medicaid
D80391Medicare UPIN