Provider Demographics
NPI:1477552115
Name:WELLER, EDWARD BROOKS (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:BROOKS
Last Name:WELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:611 N LINDSAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4300
Practice Address - Country:US
Practice Address - Phone:336-802-2250
Practice Address - Fax:336-802-2251
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2009-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC28375207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986454Medicaid
NCP00327492OtherRAILROAD MEDICARE
NC211416AMedicare PIN
NCC87087Medicare UPIN
NC8986454Medicaid