Provider Demographics
NPI:1356474456
Name:BAXTER DREW WELLMON II D.O.,P.C.
Entity Type:Organization
Organization Name:BAXTER DREW WELLMON II D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAXTER
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:WELLMON
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:717-532-3211
Mailing Address - Street 1:97 PROGRESS BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-8131
Mailing Address - Country:US
Mailing Address - Phone:717-532-3211
Mailing Address - Fax:717-532-3099
Practice Address - Street 1:97 PROGRESS BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8131
Practice Address - Country:US
Practice Address - Phone:717-532-3211
Practice Address - Fax:717-532-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009662L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty