Provider Demographics
NPI:1518007020
Name:WELLMON, BAXTER DREW II (DO)
Entity Type:Individual
Prefix:DR
First Name:BAXTER
Middle Name:DREW
Last Name:WELLMON
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 PROGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9053
Mailing Address - Country:US
Mailing Address - Phone:717-486-4117
Mailing Address - Fax:
Practice Address - Street 1:97 PROGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9053
Practice Address - Country:US
Practice Address - Phone:717-486-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009662L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01757777Medicaid
PA01757777Medicaid
PAG88041Medicare UPIN