Provider Demographics
NPI:1477500858
Name:JOSEPH M WHEATLEY
Entity Type:Organization
Organization Name:JOSEPH M WHEATLEY
Other - Org Name:MHC PROSTHETICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-997-0191
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650
Mailing Address - Country:US
Mailing Address - Phone:301-997-0191
Mailing Address - Fax:301-997-0199
Practice Address - Street 1:3710 RIVIERA STREET
Practice Address - Street 2:
Practice Address - City:MARLOW HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20748
Practice Address - Country:US
Practice Address - Phone:301-997-0191
Practice Address - Fax:301-997-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR942335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier