Provider Demographics
NPI:1487814612
Name:MAXWELL, WHEELER T (MD)
Entity Type:Individual
Prefix:
First Name:WHEELER
Middle Name:T
Last Name:MAXWELL
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 1:33 EAST CHESTNUT HILL AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2713
Mailing Address - Country:US
Mailing Address - Phone:215-247-0900
Mailing Address - Fax:215-247-7696
Practice Address - Street 1:33 EAST CHESTNUT HILL AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2713
Practice Address - Country:US
Practice Address - Phone:215-247-0900
Practice Address - Fax:215-247-7696
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine