Provider Demographics
NPI:1407893373
Name:WHEELER, NOEL SAMUEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:SAMUEL JOHN
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HERRICK ST
Mailing Address - Street 2:LAHEY PULMONARY, BEVERLY
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2734
Mailing Address - Country:US
Mailing Address - Phone:978-998-4601
Mailing Address - Fax:978-998-4973
Practice Address - Street 1:77 HERRICK ST
Practice Address - Street 2:LAHEY PULMONARY, BEVERLY
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2734
Practice Address - Country:US
Practice Address - Phone:978-998-4601
Practice Address - Fax:978-998-4973
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261560207RP1001X, 207RS0012X, 207RC0200X, 207RP1001X
NH12250207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074414Medicaid
ME1407893373Medicaid
MA110101859AMedicaid
NH3074414Medicaid
MA110101859AMedicaid
ME1407893373Medicaid