Provider Demographics
NPI:1578635728
Name:WHEELER, CHRISTOPHER L (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:WHEELER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HAMPTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4855
Mailing Address - Country:US
Mailing Address - Phone:603-775-7575
Mailing Address - Fax:603-778-9680
Practice Address - Street 1:1 HAMPTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4855
Practice Address - Country:US
Practice Address - Phone:603-775-7575
Practice Address - Fax:603-778-9680
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078261Medicaid
S46547Medicare UPIN
NH0422560001Medicare NSC
NHWHAP0705Medicare PIN
020336308OtherTAX ID#
NH30011019Medicaid
NH0422560001Medicare NSC