Provider Demographics
NPI:1609957372
Name:WHEELER, JAYANTHI EMMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JAYANTHI
Middle Name:EMMANUEL
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAYANTHI
Other - Middle Name:
Other - Last Name:EMMANUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-2503
Mailing Address - Fax:603-740-2497
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-740-2503
Practice Address - Fax:603-740-2497
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12364208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP00428678OtherRR MEDICARE
ME1609957372Medicaid
NH3075403Medicaid
NHP00428678OtherRR MEDICARE